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Jimba T, Kaneko H, Azegami T, Suzuki Y, Okada A, Ko T, Fujiu K, Takeda N, Morita H, Hayashi K, Nishiyama A, Node K, Yasunaga H, Takeda N, Nangaku M, Komuro I. Body weight change associated kidney outcomes of sodium-glucose cotransporter new users. Diabetes Obes Metab 2024. [PMID: 39072974 DOI: 10.1111/dom.15808] [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: 04/24/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024]
Abstract
AIM To investigate the clinical significance of body weight changes on kidney outcomes among individuals with diabetes using sodium-glucose cotransporter-2 (SGLT2) inhibitors. MATERIALS AND METHODS This is a retrospective cohort study using a nationwide epidemiological database, and we conducted an analysis involving 11 569 individuals with diabetes who were newly prescribed SGLT2 inhibitors. The main outcome was the rate of decline in estimated glomerular filtration rate (eGFR), determined through a linear mixed-effects model with an unstructured covariance structure. RESULTS The median age of the patients was 52 (Q1-Q3: 47-58) years, and the median fasting plasma glucose and glycated haemoglobin (HbA1c) levels were 144 (Q1-Q3: 124-175) mg/dL and 7.4 (Q1-Q3: 6.8-8.3)%, respectively. The median estimated eGFR was 77.7 (Q1-Q3: 67.2-89.1) mL/min/1.73 m2. The median follow-up period was 1.7 (Q1-Q3: 1.0-2.6) years. Participants were stratified into three groups based on the body mass index change rate tertiles between baseline and 1 year after (tertile 1: <-4.55%, tertile 2: -4.55% to -1.43%, tertile 3: >-1.43%). The annual change in eGFR was -0.78 (-0.94 to -0.63) mL/min/1.73 m2 in tertile 1, -0.95 (-1.09 to -0.81) mL/min/1.73 m2 in tertile 2, and -1.65 mL/min/1.73 m2 (-1.84 to -1.47) in tertile 3 (pinteraction < 0.001). A variety of sensitivity analyses confirmed the relationship between the 1-year body mass index decrease and favourable kidney outcomes after SGLT2 inhibitor administration. CONCLUSIONS Our analysis of a nationwide epidemiological cohort revealed that kidney outcomes following the initiation of SGLT2 inhibitors would be more favourable, with greater body weight loss observed after the initiation of SGLT2 inhibitors.
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Affiliation(s)
- Takahiro Jimba
- 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
| | - Tatsuhiko Azegami
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Suzuki
- Department of Cardiovascular Medicine, 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
| | - Toshiyuki Ko
- 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
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Hayashi
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, 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
| | - Norihiko Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
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Suzuki Y, Kaneko H, Okada A, Fujiu K, Takeda N, Morita H, Yano Y, Nishiyama A, Node K, Yasunaga H, Komuro I. BP classification using the 2017 ACC/AHA guideline with risk of cardiovascular events in older individuals. J Cardiol 2024:S0914-5087(24)00134-5. [PMID: 39067569 DOI: 10.1016/j.jjcc.2024.07.005] [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: 04/24/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The association between stage 1 hypertension and the risk of cardiovascular disease (CVD) has not been established in older adults. Furthermore, little is known about whether lowering blood pressure (BP) is beneficial in older adults with stage 1 hypertension. METHODS This cohort study analyzed nationwide data collected from the Japanese DeSC database, including 476,654 individuals aged ≥60 years. Individuals were categorized into four groups according to the 2017 ACC/AHA BP guidelines: normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension. The primary outcome was a composite CVD event, including myocardial infarction, angina pectoris, stroke, and heart failure. RESULTS During a mean follow-up of 3.1 years, 53,946 composite CVD events were recorded. Hazard ratios of stage 1 hypertension for composite CVD events, myocardial infarction, angina pectoris, stroke, and heart failure were 1.10 (95 % CI, 1.07-1.13), 1.16 (95 % CI, 1.03-1.31), 1.06 (95 % CI, 1.01-1.10), 1.13 (95 % CI, 1.08-1.18), and 1.13 (95 % CI, 1.09-1.16), respectively. Individuals with a ≥ 5 mmHg decrease in systolic BP over one year had a lower risk of stroke among individuals with stage 1 hypertension. The positive association between stage 1 hypertension and composite CVD events was attenuated in individuals aged ≥75 years. CONCLUSIONS Stage 1 hypertension is associated with a higher risk of developing CVD events among older adults. The 2017 ACC/AHA BP guidelines could be applied to older populations; however, the applicability of these guidelines to older adults aged ≥75 years requires further investigations.
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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
| | - 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
| | - Yuichiro Yano
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan; Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, 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; Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; International University of Health and Welfare, Tokyo, Japan
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Chang W, Chen Y, Lee Y, Shiu M, Chang P, Guo C, Huang C, Chiang C, Chen C, Chuang S, Cheng H. Cardiovascular Risk in Patients With Treated Isolated Diastolic Hypertension and Isolated Low Diastolic Blood Pressure. J Am Heart Assoc 2024; 13:e032771. [PMID: 38606761 PMCID: PMC11262516 DOI: 10.1161/jaha.123.032771] [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: 09/21/2023] [Accepted: 03/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The prognosis of high or markedly low diastolic blood pressure (DBP) with normalized on-treatment systolic blood pressure on major adverse cardiovascular events (MACEs) is uncertain. This study examined whether treated isolated diastolic hypertension (IDH) and treated isolated low DBP (ILDBP) were associated with MACEs in patients with hypertension. METHODS AND RESULTS A total of 7582 patients with on-treatment systolic blood pressure <130 mm Hg from SPRINT (Systolic Blood Pressure Intervention Trial) were categorized on the basis of average DBP: <60 mm Hg (n=1031; treated ILDBP), 60 to 79 mm Hg (n=5432), ≥80 mm Hg (n=1119; treated IDH). MACE risk was estimated using Cox proportional-hazards models. Among the SPRINT participants, median age was 67.0 years and 64.9% were men. Over a median follow-up of 3.4 years, 512 patients developed a MACE. The incidence of MACEs was 3.9 cases per 100 person-years for treated ILDBP, 1.9 cases for DBP 60 to 79 mm Hg, and 1.8 cases for treated IDH. Comparing with DBP 60 to 79 mm Hg, treated ILDBP was associated with an 1.32-fold MACE risk (hazard ratio [HR], 1.32, 95% CI, 1.05-1.66), whereas treated IDH was not (HR, 1.18 [95% CI, 0.87-1.59]). There was no effect modification by age, sex, atherosclerotic cardiovascular disease risk, or cardiovascular disease history (all P values for interaction >0.05). CONCLUSIONS In this secondary analysis of SPRINT, among treated patients with normalized systolic blood pressure, excessively low DBP was associated with an increased MACE risk, while treated IDH was not. Further research is required for treated ILDBP management.
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Affiliation(s)
- Wei‐Lun Chang
- Division of Faculty DevelopmentTaipei Veterans General HospitalTaipeiTaiwan
| | - Ying‐Fan Chen
- Department of Internal MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Yu‐Hsuan Lee
- Division of Faculty DevelopmentTaipei Veterans General HospitalTaipeiTaiwan
| | - Ming‐Neng Shiu
- Department of Pharmacy, College of Pharmaceutical SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Po‐Yin Chang
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug AdministrationSilver SpringMDUSA
| | - Chao‐Yu Guo
- Division of Biostatistics and Data scienceInstitute of Public Health, College of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chi‐Jung Huang
- Center for Evidence‐based MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Chern‐En Chiang
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Chen‐Huan Chen
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- ReShining ClinicTaipeiTaiwan
| | - Shao‐Yuan Chuang
- Institute of Population Health Science, National Health Research InstitutesMiaoli CountyTaiwan
| | - Hao‐Min Cheng
- Division of Faculty DevelopmentTaipei Veterans General HospitalTaipeiTaiwan
- Center for Evidence‐based MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Ph.D. Program of Interdisciplinary Medicine (PIM)National Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan
- Institute of Public HealthNational Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan
- Institute of Health and Welfare PolicyNational Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan
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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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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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Cho SMJ, Lee H, Koyama S, Zou RS, Schuermans A, Ganesh S, Hornsby W, Honigberg MC, Natarajan P. Cumulative Diastolic Blood Pressure Burden in Normal Systolic Blood Pressure and Cardiovascular Disease. Hypertension 2024; 81:273-281. [PMID: 38084606 PMCID: PMC10841692 DOI: 10.1161/hypertensionaha.123.22160] [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: 10/02/2023] [Accepted: 11/16/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND The clinical significance of isolated diastolic hypertension defined by the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines remains inconsistent. We examined whether long-term diastolic burden predicts the first major adverse cardiovascular event in participants with sustained and untreated normal systolic BP. METHODS The Mass General Brigham Biobank is a New England health care-based cohort recruited between 2010 and 2021. A total of 15 979 participants aged 18 to 64 years and without prior cardiovascular disease, antihypertensives, or high systolic BP were studied. The cumulative diastolic burden was determined as the area under the curve for diastolic BP (DBP) ≥80 mm Hg over 5 years before enrollment. Major adverse cardiovascular event was defined as a composite of first incident ischemic heart disease, stroke, heart failure, or all-cause death. RESULTS Of the 15 979 participants, mean (SD) age at enrollment was 47.6 (14.3) years, 11 950 (74.8%) were women, and the mean (SD) systolic BP and DBP were 118.0 (12.9) and 72.2 (9.3) mm Hg, respectively. Over a median (interquartile range) follow-up of 3.5 (1.8-5.4) years, 2467 (15.4%) major adverse cardiovascular events occurred. Using Cox proportional hazards regression, each SD increase in cumulative DBP was independently associated with a hazard ratio (95% CI) of 1.06 (1.02-1.10) without effect modification by sex (P=0.65), age (P=0.46), or race/ethnicity (P=0.24). In addition to traditional risk factors, cumulative DBP modestly improved the discrimination C index (95% CI) from 0.74 (0.72-0.75) to 0.75 (0.74-0.76; likelihood ratio test, P=0.037). CONCLUSIONS Among individuals with normal systolic BP, cumulative DBP may augment cardiovascular disease risk stratification beyond a single DBP measure and traditional risk factors.
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Affiliation(s)
- So Mi Jemma Cho
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Satoshi Koyama
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roger S. Zou
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Art Schuermans
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Flanders, Belgium
| | - Shriienidhie Ganesh
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Whitney Hornsby
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Michael C. Honigberg
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Pradeep Natarajan
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
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Suzuki Y, Kaneko H, Yano Y, Okada A, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Node K, Yasunaga H, Komuro I. Reduction in blood pressure for people with isolated diastolic hypertension and cardiovascular outcomes. Eur J Prev Cardiol 2023; 30:928-934. [PMID: 36416186 DOI: 10.1093/eurjpc/zwac278] [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: 04/10/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 08/02/2023]
Abstract
AIMS Isolated diastolic hypertension (IDH) is a largely underrated risk factor for cardiovascular disease (CVD). It is currently unclear whether a reduction in blood pressure (BP) is associated with CVD events among adults with IDH. We aimed to elucidate the relationship between BP reduction and incident CVD in individuals with IDH. METHODS AND RESULTS We retrospectively analysed the data of 71 297 individuals with IDH. Isolated diastolic hypertension was defined as systolic BP of < 140 mmHg and diastolic BP (DBP) of ≥90 mmHg (median age, 48 years; 83.1% men; median DBP, 92 mmHg). None of the participants took BP-lowering medications or had a history of CVD at baseline. Blood pressure was measured at baseline and 1-year follow-up, and participants were categorized into two groups based on DBP at 1 year (≥90 or < 90 mmHg). The primary outcome was a composite endpoint that included myocardial infarction, stroke, and all-cause death. Over a mean follow-up period of 1100 ± 859 days, 1317 composite CVD endpoints were recorded. Participants with DBP of < 90 mmHg at 1 year were at a lower risk of composite CVD events [hazard ratio (HR): 0.75, 95% confidence interval (CI): 0.67-0.83] than those with DBP of ≥90 mmHg at 1 year. A reduction in DBP per 5 mmHg during the 1-year follow-up was associated with a lower composite CVD event risk (HR: 0.92, 95% CI: 0.89-0.95). The results remained consistent across a multitude of sensitivity analyses. CONCLUSION Our analysis of a large-scale epidemiological dataset demonstrated a relationship of reduction in DBP with a reduced risk for CVD events in individuals with IDH.
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Affiliation(s)
- Yuta Suzuki
- Department of Cardiovascular Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 351-0197, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- Department of Advanced Cardiology, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuichiro Yano
- Department of Advanced Epidemiology, NCD Epidemiology Research Center, Shiga University of Medical Science, Tukinowa-cho, Otsu-shi, Shiga 520-2192, Japan
- Department of Family Medicine and Community Health, Duke University, 2200 W Main Street, Erwin Square Bldg, Suite 600, Durham, NC 27705, USA
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Satoshi Matsuoka
- Department of Cardiovascular Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- Department of Advanced Cardiology, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Taisuke Jo
- Department of Health Services Research, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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8
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Achilles S, Olson JD, Dugan GO, Cline JM. Assessment of Blood Pressure in Irradiated Rhesus Macaques (Macaca mulatta). Radiat Res 2023; 200:13-20. [PMID: 37083731 PMCID: PMC10481370 DOI: 10.1667/rade-22-00117.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/08/2023] [Indexed: 04/22/2023]
Abstract
There is increasing evidence that circulatory disease incidence and mortality is associated with radiation exposure. Wake Forest School of Medicine is home to a unique cohort of total-body irradiated macaques, some with evidence of vascular end-organ disease in the brain, kidney and heart. Because there is a link between high blood pressure and vascular disease in all these sites, we undertook a retrospective study to evaluate blood pressure and radiation in this cohort of animals. In this work, we utilized a cohort of nonhuman primates (rhesus macaques, Macaca mulatta) long-term survivors of high-dose total-body irradiation (1.1-8.5 Gy, N = 129) and controls (N = 37) to evaluate the effects of radiation on blood pressure and obesity. Subjects were between 3 and 22 years of age (median 9 years). Blood pressure (BP) was measured 1-14 years postirradiation (median 4 years). Subjects were sedated with a combination of ketamine HCl (15 mg/kg body weight, IM) and midazolam (0.1 mg/kg body weight, IM) and systolic, diastolic, and mean arterial pressures were measured using a high definition oscillometer. Obesity was defined by dual energy X-ray absorptiometry as a body fat percentage >35%. Statistical analysis of the collected data indicated significant increases in blood pressure with increasing age and obesity. However, radiation did not significantly alter blood pressure in irradiated animals relative to controls, radiation dose, or age of irradiation.
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Affiliation(s)
- Stephanie Achilles
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Animal Resources Program, Winston-Salem, North Carolina
| | - John D. Olson
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Animal Resources Program, Winston-Salem, North Carolina
| | - Gregory O. Dugan
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Animal Resources Program, Winston-Salem, North Carolina
| | - J. Mark Cline
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Animal Resources Program, Winston-Salem, North Carolina
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9
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Mizuno A, Kaneko H, Suzuki Y, Okada A, Takeda N, Morita H, Fujiu K, Node K, Yasunaga H, Komuro I. Enduring Relevance of the Stages of Change Model for Transforming Lifestyle Behaviors. Circ J 2023:CJ-23-0292. [PMID: 37394571 DOI: 10.1253/circj.cj-23-0292] [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: 07/04/2023]
Abstract
BACKGROUND The applicability of the Stages of Change model for cardiovascular disease-related behaviors, such as smoking, exercise, diet, and sleep quality, is unclear.Methods and Results: Using a large-scale epidemiological dataset, we found that baseline behavior change intention, as per the transtheoretical model, was associated with modifications of unhealthy lifestyles including cigarette smoking, physical inactivity, skipping breakfast, and poor sleep quality. CONCLUSIONS Our results suggest that an individual's motivation to change assessed by a general questionnaire may contribute to lifestyle modification and potentially prevent subsequent cardiovascular disease.
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Affiliation(s)
- Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital
- Leonard Davis Institute for Health Economics, University of Pennsylvania
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Advanced Cardiology, The University of Tokyo
| | - Yuta Suzuki
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Advanced Cardiology, The University of Tokyo
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - 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
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10
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Zhang X, Wang X, Wang M, Qu H, Hu B, Li Q. Prevalence, awareness, and treatment of isolated diastolic hypertension in the United States. Eur J Intern Med 2023; 112:93-99. [PMID: 37002149 DOI: 10.1016/j.ejim.2023.03.026] [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: 02/06/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Isolated diastolic hypertension (IDH) is recognized as a risk factor for cardiovascular disease, yet its clinical epidemiology remains poorly understood due to insufficient recognition. This study aims to describe the trend in the prevalence, awareness, and treatment of IDH in the United States from 2001 to 2018. METHODS This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in nine consecutive two-year cycles from 2001-2002 to 2017-2018, comprising a sample of 48,742 adults aged over 18 years. IDH was defined as a diastolic blood pressure ≥ 80 mm Hg with a systolic BP < 130 mm Hg by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. RESULTS In the nationally representative dataset, 8.9% of participants had IDH in 2017-2018, a decreased of 3.6% (95% confidence interval [CI], -2.6% to -5.0%, P<0.0002) since 2001-2002. IDH prevalence was highest among Mexican American (10.5%), individuals aged 40-59 (12.3%), increased with body mass index (BMI) (11.2% among those BMI ≥30.0 kg/m2), and tended to be higher in men (12.3%). A multiple regression analysis showed that men, white race/ethnicity, young and middle-aged people (aged 18-59), and increasing BMI were independently associated with increased risks of IDH. Among IDH patients, there was a modest increase in awareness (P<0.0002), from 22.4% (95%CI, 18.4% to 27.1%) in 2001-2002 to 35.0% (95%CI, 28.2% to 42.5%) in 2017-2018, with the largest percentage increases among non-Hispanic white and men. IDH treatment increased by 7.6% (95%CI, 3.1% to 12.1%) between 2001-2002 and 2017-2018, with the greatest increases occurring in Mexican American and men. CONCLUSION IDH prevalence is decreasing from 2001-2002 to 2017-2018 in the United States. Despite the significantly increased in both awareness and treatment, they remain below 50%.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Miaoran Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Hua Qu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | | | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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11
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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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12
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Kong G, Chin YH, Lim J, Ng CH, Kannan S, Chong B, Lin C, Chan KE, Anand VV, Lee ECZ, Loong S, Wong ZY, Khoo CM, Muthiah M, Foo R, Dimitriadis GK, Figtree GA, Wang Y, Chan M, Chew NWS. A two-decade population-based study on the effect of hypertension in the general population with obesity in the United States. Obesity (Silver Spring) 2023; 31:832-840. [PMID: 36748957 DOI: 10.1002/oby.23658] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE With rising prevalence of hypertension and obesity, the effect of hypertension in obesity remains an important global issue. The prognosis of the US general population with obesity based on hypertension control was examined. METHODS This study examined participants from the National Health and Nutrition Examination Survey between 1999 and 2018. Individuals with obesity were stratified into no hypertension, controlled hypertension, and uncontrolled hypertension. The study outcome was all-cause mortality. Cox regression of all-cause mortality was adjusted for age, sex, ethnicity, diabetes, and previous myocardial infarction. RESULTS Of 16,386 individuals with obesity, 53.1% had no hypertension, 24.7% had controlled hypertension, and 22.2% had uncontrolled hypertension. All-cause mortality was significantly higher in uncontrolled hypertension (17.1%), followed by controlled hypertension (14.8%) and no hypertension (4.0%). Uncontrolled hypertension had the highest mortality risk (hazard ratio [HR] 1.34, 95% CI: 1.13-1.59, p = 0.001), followed by controlled hypertension (HR 1.21, 95% CI: 1.10-1.34, p < 0.001), compared with no hypertension after adjustment. The excess mortality trend was more pronounced in females, those with diabetes, and those older than age 65 years. CONCLUSIONS The incremental mortality risk in controlled and uncontrolled hypertension, compared with the normotensive counterparts, irrespective of sex, age, and diabetes status, urges health care providers to optimize hypertension control and advocate weight loss to achieve better outcomes in obesity.
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Affiliation(s)
- Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip H Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jieyu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng H Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shankar Kannan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai E Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vickram V Anand
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ethan C Z Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Shaun Loong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhen Y Wong
- Nottingham University Hospitals NHS Trust, Nottingham, England, UK
| | - Chin M Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Mark Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Georgios K Dimitriadis
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
- Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes, Faculty of Cardiovascular Medicine & Sciences, School of Life Course Sciences, King's College London, London, UK
| | - Gemma A Figtree
- Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Mark Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
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13
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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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14
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Kaneko H, Yano Y, Okada A, Itoh H, Suzuki Y, Yokota I, Morita K, Fujiu K, Michihata N, Jo T, Yamaguchi S, Takeda N, Morita H, Node K, Yamauchi T, Nangaku M, Kadowaki T, McEvoy JW, Lam CSP, Yasunaga H, Komuro I. Age-Dependent Association Between Modifiable Risk Factors and Incident Cardiovascular Disease. J Am Heart Assoc 2023; 12:e027684. [PMID: 36628975 PMCID: PMC9939069 DOI: 10.1161/jaha.122.027684] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background There have been limited data examining the age-dependent relationship of wide-range risk factors with the incidence of each subtype of cardiovascular disease (CVD) event. We assessed age-related associations between modifiable risk factors and the incidence of CVD. Methods and Results We analyzed 3 027 839 participants without a CVD history enrolled in the JMDC Claims Database (mean age, 44.8±11.0 years; 57.6% men). Each participant was categorized as aged 20 to 49 years (n=2 008 559), 50 to 59 years (n=712 273), and 60 to 75 years (n=307 007). Using Cox proportional hazards models and the relative risk reduction, we identified associations between risk factors and incident CVD, consisting of myocardial infarction, angina pectoris, stroke, and heart failure (HF). We assessed whether the association of risk factors for developing CVD would be modified by age category. Over a mean follow-up of 1133 days, 6315 myocardial infarction, 56 447 angina pectoris, 28 079 stroke, and 56 369 HF events were recorded. The incidence of myocardial infarction, angina pectoris, stroke, and HF increased with age category. Hazard ratios of obesity, hypertension, and diabetes in the multivariable Cox regression analyses for myocardial infarction, angina pectoris, stroke, and HF decreased with age category. The relative risk reduction of obesity, hypertension, and diabetes for CVD events decreased with age category. For example, the relative risk reduction of hypertension for HF decreased from 59.2% in participants aged 20 to 49 years to 38.1% in those aged 60 to 75 years. Conclusions The contribution of modifiable risk factor to the development of CVD is greater in younger compared with older individuals. Preventive efforts for risk factor modification may be more effective in younger people.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular MedicineThe University of TokyoJapan,Department of Advanced CardiologyThe University of TokyoJapan
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical TrialsYokohama City University HospitalYokohamaJapan,Department of Family Medicine and Community HealthDuke UniversityDurhamNC
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoJapan
| | - Hidetaka Itoh
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Yuta Suzuki
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Isao Yokota
- Department of Biostatistics, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoJapan
| | - Katsuhito Fujiu
- Department of Cardiovascular MedicineThe University of TokyoJapan,Department of Advanced CardiologyThe University of TokyoJapan
| | | | - Taisuke Jo
- Department of Health Services ResearchThe University of TokyoJapan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoJapan
| | - Norifumi Takeda
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineThe University of TokyoJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of MedicineThe University of TokyoJapan
| | - Masaomi Nangaku
- Division of Nephrology and EndocrinologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of MedicineThe University of TokyoJapan,Toranomon HospitalTokyoJapan
| | - John W. McEvoy
- National Institute for Prevention and Cardiovascular HealthNational University of IrelandGalwayIreland,Johns Hopkins Ciccarone Center for Cardiovascular Disease PreventionJohns Hopkins University School of MedicineBaltimoreMD
| | - Carolyn S. P. Lam
- National Heart Centre SingaporeSingapore,Duke‐NUS Medical SchoolSingapore,Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineThe University of TokyoJapan
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15
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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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16
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Suzuki Y, Kaneko H, Yano Y, 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. Glycemic status and the association of change in blood pressure with incident cardiovascular disease. Am Heart J 2022; 254:48-56. [PMID: 35872125 DOI: 10.1016/j.ahj.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The clinical benefit of blood pressure (BP) reduction in individuals with diabetes has not been fully elucidated. We sought to identify the clinical impact of BP reduction on incident cardiovascular disease in people having diabetes and hypertension. METHODS We conducted a retrospective cohort study including 754,677 individuals (median age 47 years, 75.8 % men) with stage 1/stage 2 hypertension. Participants were categorized using fasting plasma glucose (FPG) at baseline as normal FPG (FPG < 100 mg/dL) (n = 517,372), prediabetes (FPG:100-125 mg/dL) (n = 197,836), or diabetes mellitus (FPG ≥126 mg/dL) (n = 39,469). The primary outcome was heart failure (HF), and the secondary outcomes included ischemic heart disease (IHD) including myocardial infarction and angina pectoris, and stroke. RESULTS Over a mean follow-up of 1111 ± 909 days, 18,429 HFs, 17,058 IHDs, and 8,795 strokes were recorded. Reduction in BP of< 120/80 mmHg at 1year was associated with a lower risk of developing HF (HR:0.77, 95% CI:0.72-0.82), IHD (HR:0.84, 95% CI:0.79-0.89), and stroke (HR:0.75, 95% CI:0.69-0.82) in individuals with normal FPG, whereas it was not associated with a risk of developing HF (HR:0.98, 95% CI:0.81-1.17) and stroke (HR:0.82, 95% CI:0.62-1.09) in those with DM. Interaction analyses showed that the influence of BP reduction on incident HF was attenuated with people with prediabetes or DM. A multitude of sensitivity analyses confirmed our results. CONCLUSIONS The association of BP reduction with the risk of developing HF was attenuated with deteriorating glucose tolerance. The optimal management strategy for hypertensive people with prediabetes or DM for the prevention of developing cardiovascular disease (particularly HF) is needed to be established.
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Affiliation(s)
- Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, 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, 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
| | - 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, 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; Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, 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 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, Tokyo, Japan
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17
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Suzuki Y, Kaneko H, Yano Y, Okada A, Hashimoto Y, Itoh H, Matsuoka S, Yokota I, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Kamiya K, Matsunaga A, Ako J, Node K, Yasunaga H, Komuro I. Threshold of BMI for the Development of Hypertension among Japanese Adults. J Nutr 2022; 152:2565-2571. [PMID: 36774122 DOI: 10.1093/jn/nxac192] [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: 04/22/2022] [Revised: 07/16/2022] [Accepted: 08/23/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The optimal value of BMI for the development of hypertension and the influence of BMI on the development of stage 1 or stage 2 hypertension remain unclear. OBJECTIVES We sought to identify the BMI threshold for the prevention of hypertension and how changes in BMI would influence the risk of developing hypertension. METHODS We analyzed 1,262,356 participants (median age: 43 y; 50.9% men) with normal blood pressure [BP; systolic BP (SBP) <120 mmHg and diastolic BP (DBP) <80 mmHg] or elevated BP (SBP: 120-129 mmHg and DBP <80 mmHg). The primary outcome was stage 1 (SBP 130-139 mmHg or DBP 80-89 mmHg) or stage 2 hypertension (SBP ≥140 mmHg or DBP ≥90 mmHg). We analyzed the relation between baseline BMI, change in BMI, and the risk of developing hypertension using generalized additive models with a smoothing spline. RESULTS During the median follow-up of 851 d, 341,212 cases of stage 1 hypertension and 70,968 cases of stage 2 hypertension were detected. The risk of developing stage 1 or stage 2 hypertension increased steeply after BMI (kg/m2) exceeded 20. The annual change in BMI was positively correlated with the risk of developing stage 1 or 2 hypertension. Contour mapping using generalized additive models demonstrated an additive increase in the risk of developing hypertension with higher baseline BMI and increases in BMI over 1 y. Body-weight gain increases the risk of developing hypertension even in underweight or normal-weight individuals based on the WHO classification. CONCLUSIONS In Japanese adults with normal or elevated BP, the risk of developing hypertension increased with BMI when baseline BMI was >20. Body-weight gain additively interacted with baseline BMI during hypertension development. Our results underscore the importance of maintaining body weight in preventing the development of hypertension.
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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
| | - Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Matsuoka
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Isao Yokota
- Department of Biostatistics, Faculty of Medicine, Hokkaido University, Sapporo, 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
| | - 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
- 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
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18
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Kim SH, Shin C, Kim S, Kim JS, Lim SY, Seo HS, Lim HE, Sung KC, Cho GY, Lee SK, Kim YH. Prevalence of Isolated Nocturnal Hypertension and Development of Arterial Stiffness, Left Ventricular Hypertrophy, and Silent Cerebrovascular Lesions: The KoGES (Korean Genome and Epidemiology Study). J Am Heart Assoc 2022; 11:e025641. [PMID: 36193933 DOI: 10.1161/jaha.122.025641] [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: 11/16/2022]
Abstract
Background Apart from nondippers' impact on cardiovascular events, the prevalence of isolated nocturnal hypertension (INH) and its consequences on both the heart and brain were not clearly investigated in the general population. Methods and Results The participants underwent ambulatory blood pressure monitoring evaluations for arterial stiffness, echocardiography, and brain magnetic resonance imaging. They were grouped into normotension, INH, and overt diurnal hypertension, based on ambulatory blood pressure monitoring and history of antihypertensive treatment. White matter hyperintensity, arterial stiffness, and echocardiographic parameters were compared. Of the 1734 participants, there were 475 (27.4%) subjects with normotension, 314 with INH (18.1%), and 945 with overt diurnal hypertension (54.5%). Prevalence of INH was not different between sex or age. Of INH, 71.3% (n=224) was caused by elevated diastolic blood pressure. After multivariable adjustment, INH showed higher pulse wave velocity (P<0.001) and central systolic blood pressure (P<0.001), left ventricular mass index (P=0.026), and worse left ventricular diastolic function (early diastolic mitral annular velocity) (P<0.001) than normotension. Mean white matter hyperintensity scores of INH were not different from normotension (P=0.321), but the odds for white matter hyperintensity presence were higher in INH than normotension (odds ratio, 1.504 [95% CI, 1.097-2.062]; P=0.011). Conclusions INH was common in the general population and associated with increased arterial stiffness, left ventricular hypertrophy, and diastolic dysfunction. White matter hyperintensity was more likely to be present in the INH group than in the normotension group. The use of ambulatory blood pressure monitoring should be encouraged to identify masked INH and prevent the occurrence of cardiovascular events.
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Affiliation(s)
- Seong Hwan Kim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, Department of Radiology Korea University Ansan Hospital Ansan Republic of Korea
| | - Sunwon Kim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
| | - Sang Yup Lim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
| | - Hyeong-Seok Seo
- Institute of Human Genomic Study, Department of Radiology Korea University Ansan Hospital Ansan Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Department of Internal Medicine Hallym University Sacred Heart Hospital Anyang Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine Kangbuk Samsung Medical Center Seoul Republic of Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, Department of Radiology Korea University Ansan Hospital Ansan Republic of Korea
| | - Yong-Hyun Kim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
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19
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Suzuki Y, Kaneko H, Yano Y, Okada A, Itoh H, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Matsunaga A, Node K, McEvoy JW, Lam CSP, Oparil S, Yasunaga H, Komuro I. Association of Cardiovascular Health Metrics With Risk of Transition to Hypertension in Non-Hypertensive Young Adults. Am J Hypertens 2022; 35:858-866. [PMID: 35639507 DOI: 10.1093/ajh/hpac057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The risk of developing hypertension in young adults and its relationship to modifiable lifestyle factors are unclear. We aimed to examine the association of cardiovascular health (CVH) metrics with the risk of hypertension. METHODS We analyzed 66,876 participants aged 20-39 years, with available blood pressure (BP) data for 5 consecutive years, who had normal or elevated BP at the initial health check-up, enrolled in the JMDC Claims Database. Ideal CVH metrics included nonsmoking, body mass index <25 kg/m2, physical activity at goal, optimal dietary habits, untreated fasting glucose <100 mg/dL, and untreated total cholesterol <200 mg/dL. The primary endpoint was defined as stage 1 or stage 2 hypertension. We defined normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) BP guideline. RESULTS The median age was 35 years, and 62% were men. Number of non-ideal CVH metrics was associated with an increasing risk for the development of stage 1 and stage 2 hypertension. Non-ideal body mass index was most strongly associated with a risk for hypertension. This association was more pronounced in women. An annual increase in the number of non-ideal CVH metrics was associated with an elevated risk for the hypertension development. CONCLUSIONS CVH metrics can stratify the risk for hypertension in non-hypertensive adults aged 20-39 years. These findings have important public health implications for the screening and prevention of hypertension. Improving CVH metrics may prevent the risk of developing hypertension in young adults.
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Affiliation(s)
- Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, 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, Tokyo, Japan.,The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan.,The Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - 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, Tokyo, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Cardiology, New Tokyo Hospital, Matsudo, 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
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.,The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Johns Hopkins Ciccarone Center for Cardiovascular Disease Prevention, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - 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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20
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Yue L, Chen H, Sun Q, Shi L, Sun J, Li G, Xing L, Liu S. Prevalence of isolated diastolic hypertension and the risk of cardiovascular mortality among adults aged 40 years and older in northeast China: a prospective cohort study. BMJ Open 2022; 12:e061762. [PMID: 36115666 PMCID: PMC9486366 DOI: 10.1136/bmjopen-2022-061762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Little is known about the prevalence and impact of isolated diastolic hypertension (IDH) in northeast China. We aimed to investigate the current epidemiology of IDH and to illustrate whether IDH accounted for cardiovascular disease (CVD) mortality. DESIGN A prospective cohort study. SETTING A population-based study carried out in northeast China. PARTICIPANTS We built a community-based study of 18 796 residents aged ≥40 years who were living in northeast China with blood pressure measurements between September 2017 and March 2019. OUTCOME MEASURES Information on CVD death was obtained from baseline until 31 July 2021. IDH was defined as a diastolic blood pressure ≥90 mm Hg together with systolic blood pressure <140 mm Hg among hypertensive population. RESULTS The overall prevalence of IDH was 3.9%, which decreased significantly with advancing age (p<0.001) and ranged from 7.2% (95% CI: 6.3% to 8.2%) among participants 40-49 years to 1.5% (95% CI: 1.1% to 2.0%) among participants ≥70 years. Moreover, the IDH prevalence was higher in men than in women (5.2% vs 3.1%, p<0.001). The awareness and treatment rates of IDH were 25.7% and 17.7%, respectively, which were significantly lower than those of patients with non-IDH (50.1% and 21.7%, p=0.009, respectively). During a median follow-up of 3.2 years, 314 subjects died due to CVD (rate 4.84/1000 person-years). IDH and non-IDH were both significantly associated with an increased risk of CVD death (HR: 2.55, 95% CI: 1.35 to 4.82; HR: 2.48, 95% CI: 1.81 to 3.38) when compared with participants with non-hypertension. CONCLUSIONS IDH was mainly prevalent among young and middle-aged populations, and the awareness and treatment rates in IDH were lower than those in non-IDH hypertension. Additionally, IDH and non-IDH were significantly related to an increased risk of CVD mortality. Early management of IDH is urgently required in northeast China.
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Affiliation(s)
- Ling Yue
- Department of Ultrasound, The Fourth Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Hongyun Chen
- Department of Cardiology, Dalian Municipal Central Hospital, Dalian, Liaoning, People's Republic of China
| | - Qun Sun
- Department of Chronic Disease, Disease Control and Prevention of Chao Yang City, Chaoyang, Liaoning, People's Republic of China
| | - Lei Shi
- Department of Chronic Disease, Disease Control and Prevention of Liao Yang City, Liaoyang, Liaoning, People's Republic of China
| | - Jixu Sun
- Department of Chronic Disease, Disease Control and Prevention of Dan Dong City, Dandong, Liaoning, People's Republic of China
| | - Guangxiao Li
- Department of Medical Record Management Center, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Liying Xing
- Department of Chronic Disease Preventive and Control, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, Liaoning, People's Republic of China
| | - Shuang Liu
- Department of Ultrasound, The Fourth Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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21
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Kaneko H, Yano Y, Suzuki Y, Okada A, Itoh H, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Node K, Viera AJ, Lima JAC, Oparil S, Lam CSP, Carey RM, Yasunaga H, Komuro I. Reduction in blood pressure for elevated blood pressure/stage 1 hypertension according to the ACC/AHA guideline and cardiovascular outcomes. Eur J Prev Cardiol 2022; 29:1921-1929. [DOI: 10.1093/eurjpc/zwac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Few studies have examined the relationship of blood pressure (BP) change in adults with elevated BP or stage 1 hypertension according to the ACC/AHA guideline with cardiovascular outcomes. We sought to identify the effect of BP change among individuals with elevated BP or stage 1 hypertension on incident heart failure (HF) and other cardiovascular diseases (CVDs).
Methods and results
We conducted a retrospective cohort study including 616,483 individuals (median age 46 years, 73.7% men) with elevated BP or stage 1 hypertension based on the ACC/AHA BP guideline. Participants were categorized using BP classification at one-year as normal BP (n = 173,558), elevated BP/stage 1 hypertension (n = 367,454), or stage 2 hypertension (n = 75,471). The primary outcome was HF, and the secondary outcomes included (separately) myocardial infarction (MI), angina pectoris (AP), and stroke. Over a mean follow-up of 1,097 ± 908 days, 10,544 HFs, 1,317 MIs, 11,070 APs, and 5,198 strokes were recorded. Compared with elevated BP/stage 1 hypertension at one-year, normal BP at one-year was associated with a lower risk of developing HF (HR:0.89, 95% CI:0.85-0.94), whereas stage 2 hypertension at one-year was associated with an elevated risk of developing HF (HR:1.43, 95% CI:1.36-1.51). This association was also present in other cardiovascular outcomes including MI, AP, and stroke. The relationship was consistent in all subgroups stratified by age, sex, baseline BP category, and overweight/obesity.
Conclusion
A one-year decline in BP was associated with the lower risk of HF, MI, AP, and stroke, suggesting the importance of lowering BP in individuals with elevated BP or stage 1 hypertension according to the ACC/AHA guideline to prevent the risk of developing CVD.
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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 , 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
| | - 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 , 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
| | - Anthony J Viera
- The Department of Family Medicine and Community Health, Duke University , Durham, NC
| | - Joao AC Lima
- Division of Cardiology, Johns Hopkins University School of Medicine , Baltimore, Md
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham , Birmingham, AL
| | - Carolyn S P Lam
- National Heart Centre Singapore , Singapore
- Duke-NUS Medical School , Singapore
- Department of Cardiology, University of Groningen, University Medical Centre Groningen , Groningen , Netherlands
| | - Robert M Carey
- Department of Medicine, University of Virginia Health System , Charlottesville, VA
| | - 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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22
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Jacobsen AP, McKittrick M, Daya N, Rifai MA, McEvoy JW. Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension-Con Side of the Argument. Hypertension 2022; 79:1571-1578. [PMID: 35861748 PMCID: PMC10949136 DOI: 10.1161/hypertensionaha.122.18458] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alan P. Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Myles McKittrick
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Natalie Daya
- Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mahmoud Al Rifai
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - John W. McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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23
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Yano Y, Kim HC, Lee H, Azahar N, Ahmed S, Kitaoka K, Kaneko H, Kawai F, Mizuno A, Viera AJ. Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Pro Side of the Argument. Hypertension 2022; 79:1563-1570. [PMID: 35861749 DOI: 10.1161/hypertensionaha.122.18459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Isolated diastolic hypertension (IDH), defined as diastolic blood pressure in the hypertensive range but systolic blood pressure not in the hypertensive range, is not uncommon (<20%) among adults with hypertension. IDH often manifests in concurrence with other cardiovascular risk factors. Individuals with IDH tend to have lower awareness of their hypertension compared with those with both systolic and diastolic hypertension. IDH appears to be a largely underrated risk factor for cardiovascular disease events, which may be explained by inconsistent association of IDH with cardiovascular disease events. The inconsistency suggests that IDH is heterogeneous. One size does not seem to fit all in the clinical management of individuals with IDH. Rather than treating IDH as a monolithic low-risk condition, detailed phenotyping in the context of individual comprehensive cardiovascular risk would seem to be most useful to assess an individual's expected net benefit from therapy. In this review, we highlight that the clinical relevance of IDH differs by individual clinical characteristics, and elucidate groups of individuals with IDH that should be wary of cardiovascular disease risks.
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Affiliation(s)
- Yuichiro Yano
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Family Medicine and Community Health, Duke University, NC (Y.Y., A.J.V.).,Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Japan (Y.Y.).,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (Y.Y., H.C.K., H.L.)
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (Y.Y., H.C.K., H.L.)
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (Y.Y., H.C.K., H.L.)
| | - Nazar Azahar
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Pulau Pinang, Kampus Bertam, Malaysia (N.A.)
| | - Sabrina Ahmed
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan
| | - Kaori Kitaoka
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine and the Department of Advanced Cardiology, Departments of Cardiovascular Medicine (H.K.), The University of Tokyo, Japan.,Advanced Cardiology (H.K.), The University of Tokyo, Japan
| | - Fujimi Kawai
- Library, Center for Academic Resources (F.K.), St. Luke's International University, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan (A.M.).,Department of Cardiovascular Medicine (A.M.), St. Luke's International University, Tokyo, Japan
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, NC (Y.Y., A.J.V.)
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24
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Kaneko H, Yano Y, Lee HH, Lee H, Okada A, Itoh H, Morita K, Fukui A, Fujiu K, Suzuki Y, Matsuoka S, Nakamura S, Michihata N, Jo T, Takeda N, Morita H, Yokoo T, Nishiyama A, Node K, Viera AJ, Muntner P, Oparil S, Kim HC, Yasunaga H, Komuro I. Medication-Naïve Blood Pressure and Incident Cancers: Analysis of 2 Nationwide Population-Based Databases. Am J Hypertens 2022; 35:731-739. [PMID: 35512273 DOI: 10.1093/ajh/hpac054] [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: 01/18/2022] [Revised: 02/23/2022] [Accepted: 05/01/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Results of preceding studies on the relationship between blood pressure (BP) and cancers have been confounded due to individuals taking antihypertensive medications or shared risk factors. We assessed whether medication-naïve high BP is a risk factor for incident cancers. METHODS This retrospective observational study included 1,388,331 individuals without a prior history of cancer and not taking antihypertensive medications enrolled in the JMDC Claims Database between 2005 and 2018. The primary outcome was 16 cancers. RESULTS The median [interquartile range] age was 45 [40-52] years and 56.2% were men. Mean systolic BP (SBP) and diastolic BP (DBP) were 117.7 ± 15.8 and 72.8 ± 11.6 mm Hg. Multivariate Cox regression analysis demonstrated that SBP per 1-SD was associated with a higher incidence of thyroid (hazard ratio [HR]: 1.09, 95% confidence interval [CI]: 1.03-1.16), esophageal (HR: 1.15, 95% CI: 1.07-1.24), colorectal (HR: 1.04, 95% CI: 1.01-1.07), liver (HR: 1.11, 95% CI: 1.03-1.20), and kidney (HR: 1.22, 95% CI: 1.14-1.31) cancers, but with a lower incidence of stomach cancer (HR: 0.94, 95% CI: 0.91-0.98). These associations remained significant after adjustment for multiple testing. DBP was associated with higher incidences of thyroid, esophageal, colorectal, kidney, and corpus uteri cancers, but with a lower incidence of stomach cancer. The associations between SBP and incidences of thyroid, esophageal, colorectal, liver, and kidney cancers were confirmed in the Korean National Health Insurance Service database. CONCLUSIONS Medication-naïve BP was associated with higher incidences of thyroid, esophageal, colorectal, liver, and kidney cancers. Uncovering the underlying mechanisms for our results may help identify novel therapeutic approach for hypertension and cancer.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan.,Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Hyeok-Hee Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhito Fujiu
- 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
| | - Satoshi Matsuoka
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, 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
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - 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
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25
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Mai H, Li C, Chen K, Wu Z, Liang X, Wang Y, Chen T, Chen F. Hypertension Subtypes, Mortality Risk, and Differential Effects Between Two Hypertension Guidelines. Front Med (Lausanne) 2022; 9:814215. [PMID: 35865177 PMCID: PMC9295617 DOI: 10.3389/fmed.2022.814215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
Aim: To examine which hypertension subtypes are primarily responsible for the difference in the hypertension prevalence and treatment recommendations, and to assess their mortality risk if 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline were adopted among Chinese adults. Methods We used the nationally representative data of China Health and Retirement Longitudinal Study (CHARLS) to estimate the differences in the prevalence of isolated systolic hypertension (ISH), systolic diastolic hypertension (SDH) and isolated diastolic hypertension (IDH) between the 2017 ACC/AHA and the 2018 China Hypertension League (CHL) guidelines. We further assessed their mortality risk using follow-up data from the China Health and Nutrition Survey (CHNS) by the Cox model. Results The increase from the 2017 ACC/AHA guideline on hypertension prevalence was mostly from SDH (8.64% by CHL to 25.59% by ACC/AHA), followed by IDH (2.42 to 6.93%). However, the difference was minuscule in the proportion of people recommended for antihypertensive treatment among people with IDH (2.42 to 3.34%) or ISH (12.00 to 12.73%). Among 22,184 participants with a median follow-up of 6.14 years from CHNS, attenuated but significant associations were observed between all-cause mortality and SDH (hazard ratio 1.56; 95% CI: 1.36,1.79) and ISH (1.29; 1.03,1.61) by ACC/AHA but null association for IDH (1.15; 0.98,1.35). Conclusion Adoption of the 2017 ACC/AHA may be applicable to improve the unacceptable hypertension control rate among Chinese adults but with cautions for the drug therapy among millions of subjects with IDH.
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Affiliation(s)
- Hui Mai
- Department of Neurology, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- *Correspondence: Chao Li
| | - Kangyu Chen
- Division of Life Sciences and Medicine, Department of Cardiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Zhenqiang Wu
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Xuanyi Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Yongjuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Tao Chen
- Department of Public Health, Policy and Systems, Institute of Population Health, Whelan Building, Quadrangle, The University of Liverpool, Liverpool, United Kingdom
- Tao Chen
| | - Fengjian Chen
- Department of Neurology, Central People's Hospital of Zhanjiang, Zhanjiang, China
- Fengjian Chen
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26
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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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27
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Suzuki Y, Kaneko H, Yano Y, Okada A, Itoh H, Matsuoka S, Fujiu K, Yamaguchi S, Michihata N, Jo T, Takeda N, Morita H, Node K, Kim HC, Viera AJ, Oparil S, Yasunaga H, Komuro I. Age-Dependent Relationship of Hypertension Subtypes With Incident Heart Failure. J Am Heart Assoc 2022; 11:e025406. [PMID: 35475350 PMCID: PMC9238621 DOI: 10.1161/jaha.121.025406] [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] [Indexed: 11/16/2022]
Abstract
Background The prevalence of hypertension subtypes changes with age. However, little is known regarding the age-dependent association of hypertension subtypes with incident heart failure (HF). Methods and Results We conducted an observational cohort study including 2 612 570 people (mean age, 44.0 years; 55.0% men). No participants were taking blood pressure-lowering medications or had a known history of cardiovascular disease. Participants were categorized as aged 20 to 49 years (n=1 825 756), 50 to 59 years (n=571 574), or 60 to 75 years (n=215 240). We defined stage 1 hypertension as systolic blood pressure (SBP) 130 to 139 mm Hg or diastolic blood pressure (DBP) 80 to 89 mm Hg and stage 2 hypertension as SBP ≥140 mm Hg or DBP ≥90 mm Hg. Among participants with stage 2 hypertension, isolated diastolic hypertension was defined as SBP <140 mm Hg and DBP ≥90 mm Hg, isolated systolic hypertension as SBP ≥140 mm Hg and DBP <90 mm Hg, and systolic diastolic hypertension as SBP ≥140 mm Hg and DBP ≥90 mm Hg. During a mean follow-up of 1205±934 days, 43 415 HF, 4807 myocardial infarction, 45 365 angina pectoris, 22 179 stroke, and 10 420 atrial fibrillation events occurred. Although the incidence of HF and other cardiovascular disease events increased with age, hazard ratios and relative risk reductions of each hypertension subtype for HF decreased with age. An age-dependent relationship between hypertension subtypes and incident HF was similarly observed in both men and women. Conclusions The contribution of isolated diastolic hypertension, isolated systolic hypertension, and systolic diastolic hypertension to the development of HF and other cardiovascular disease events was attenuated with age, suggesting that preventive efforts for blood pressure control could provide a greater benefit in younger individuals.
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Affiliation(s)
- Yuta Suzuki
- 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
| | - 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 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
| | - Satoko Yamaguchi
- 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
| | - Koichi Node
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Hyeon-Chang Kim
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea.,Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Anthony J Viera
- The Department of Family Medicine and Community Health Duke University Durham NC
| | - Suzanne Oparil
- Division of Cardiovascular Disease Department of Medicine University of Alabama at Birmingham Birmingham AL
| | - 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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28
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Vemuri R, Ruggiero A, Whitfield JM, Dugan GO, Cline JM, Block MR, Guo H, Kavanagh K. Hypertension promotes microbial translocation and dysbiotic shifts in the fecal microbiome of nonhuman primates. Am J Physiol Heart Circ Physiol 2022; 322:H474-H485. [PMID: 35148233 PMCID: PMC8897002 DOI: 10.1152/ajpheart.00530.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Accumulating evidence indicates a link between gut barrier dysfunction and hypertension. However, it is unclear whether hypertension causes gut barrier dysfunction or vice versa and whether the gut microbiome plays a role. To understand this relationship, we first cross-sectionally examined 153 nonhuman primates [NHPs; Chlorocebus aethiops sabaeus; mean age, 16 ± 0.4 yr; 129 (84.3%) females] for cardiometabolic risk factors and gut barrier function biomarkers. This analysis identified blood pressure and age as specific factors that independently associated with microbial translocation. We then longitudinally tracked male, age-matched spontaneously hypertensive NHPs (Macaca mulatta) to normotensives (n = 16), mean age of 5.8 ± 0.5 yr, to confirm hypertension-related gut barrier dysfunction and to explore the role of microbiome by comparing groups at baseline, 12, and 27 mo. Collectively, hypertensive animals in both studies showed evidence of gut barrier dysfunction (i.e., microbial translocation), as indicated by higher plasma levels of lipopolysaccharide-binding protein (LBP)-1, when compared with normotensive animals. Furthermore, plasma LBP-1 levels were correlated with diastolic blood pressure, independent of age and other health markers, suggesting specificity of the effect of hypertension on microbial translocation. In over 2 yr of longitudinal assessment, hypertensive animals had escalating plasma levels of LBP-1 and greater bacterial gene expression in mesenteric lymph nodes compared with normotensive animals, confirming microbes translocated across the intestinal barrier. Concomitantly, we identified distinct shifts in the gut microbial signature of hypertensive versus normotensive animals at 12 and 27 mo. These results suggest that hypertension contributes to microbial translocation in the gut and eventually unhealthy shifts in the gut microbiome, possibly contributing to poor health outcomes, providing further impetus for the management of hypertension.NEW & NOTEWORTHY Hypertension specifically had detrimental effects on microbial translocation when age and metabolic syndrome criteria were evaluated as drivers of cardiovascular disease in a relevant nonhuman primate model. Intestinal barrier function exponentially decayed over time with chronic hypertension, and microbial translocation was confirmed by detection of more microbial genes in regional draining lymph nodes. Chronic hypertension resulted in fecal microbial dysbiosis and elevations of the biomarker NT-proBNP. This study provides insights on the barrier dysfunction, dysbiosis, and hypertension in controlled studies of nonhuman primates. Our study includes a longitudinal component comparing naturally occurring hypertensive to normotensive primates to confirm microbial translocation and dysbiotic microbiome development. Hypertension is an underappreciated driver of subclinical endotoxemia that can drive chronic inflammatory diseases.
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Affiliation(s)
- Ravichandra Vemuri
- 1Section on Comparative Medicine, Department of Pathology, Wake Forest School of Medicine, Winston‐Salem, North Carolina
| | - Alistaire Ruggiero
- 1Section on Comparative Medicine, Department of Pathology, Wake Forest School of Medicine, Winston‐Salem, North Carolina
| | - Jordyn M. Whitfield
- 1Section on Comparative Medicine, Department of Pathology, Wake Forest School of Medicine, Winston‐Salem, North Carolina
| | - Greg O. Dugan
- 1Section on Comparative Medicine, Department of Pathology, Wake Forest School of Medicine, Winston‐Salem, North Carolina
| | - J. Mark Cline
- 1Section on Comparative Medicine, Department of Pathology, Wake Forest School of Medicine, Winston‐Salem, North Carolina
| | - Masha R. Block
- 1Section on Comparative Medicine, Department of Pathology, Wake Forest School of Medicine, Winston‐Salem, North Carolina
| | - Hao Guo
- 2Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,3Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kylie Kavanagh
- 1Section on Comparative Medicine, Department of Pathology, Wake Forest School of Medicine, Winston‐Salem, North Carolina,4Department of Biomedicine, University of Tasmania, Hobart, Tasmania, Australia
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29
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Application of the 2017 American college of cardiology/American Heart Association Blood Pressure Guidelines for cardiovascular outcomes among Tehranian residents. J Hypertens 2022; 40:924-932. [PMID: 35185119 DOI: 10.1097/hjh.0000000000003094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the associations of cardiovascular disease (CVD) outcomes with elevated blood pressure (BP), stage I of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH), defined by 2017 ACC/AHA guidelines among the Tehranian adult population. METHOD We enrolled 7068 residents of Tehran (district No. 13) aged at least 30 years, who were free of CVD and not taking antihypertensive medications at baseline. Participants were categorized into eight categories: normal BP (reference group), elevated BP, stage I IDH, stage I ISH, stage I SDH, and all stage II phenotypes. Significant interactions were found between age groups (<60 versus ≥60 years) and BP categories (P value: 0.017); hence, the analysis was performed in each age group, separately. We used multivariable Cox proportional regression analysis to evaluate the association of different BP categories with incident CVD. RESULTS During 18 years of follow-up, 1053 CVD events occurred. In the younger group, stage I of IDH and SDH were associated with increased CVD risk with hazard ratios of 1.23 (95% confidence interval: 0.99-1.52) and 1.42 (1.04-1.94), respectively. In the older group, stage I of IDH had a lower risk for coronary heart disease (CHD) [hazard ratio 0.53 (0.29-0.96)]. As a sensitivity analysis, among high CVD risk individuals (10-year risk >10%), we found a higher risk for CVD among those with elevated BP and stage I of SDH. For individuals with 10-year risk less than 10%, all BP parameters, except stage I of IDH, were associated with increased CVD risk. Although there was no significant interaction between sex and BP categories, elevated BP and stage I of SDH significantly increased the risk of CVD only among men. CONCLUSION Age is an important potential modifier in the association between stage I of hypertension and CVD/CHD risk. Stage I of IDH was not an alarming status for CVD development, whether the participants had a high CVD risk or not.
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30
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Isolated diastolic hypertension is not associated with endothelial dysfunction. Hypertens Res 2022; 45:698-707. [PMID: 35115698 DOI: 10.1038/s41440-022-00854-y] [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: 09/13/2021] [Revised: 11/10/2021] [Accepted: 12/20/2021] [Indexed: 11/08/2022]
Abstract
Hypertension is associated with an impairment of endothelial function. However, it is unclear whether isolated diastolic hypertension is associated with endothelial dysfunction. The purpose of this study was to investigate the association of endothelial function with isolated diastolic hypertension diagnosed by using two major hypertension guidelines: systolic blood pressure (BP) < 130 mmHg and diastolic BP ≥ 80 mmHg according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline and systolic BP < 140 mmHg and diastolic BP ≥ 90 mmHg according to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) hypertension guideline. We measured the flow-mediated vasodilation (FMD) of the brachial artery in subjects without systolic hypertension who were not treated with antihypertensive drugs. Of 3727 subjects (2813 men; mean age: 41.3 ± 10.9 years), 749 (20.1%) had isolated diastolic hypertension according to the 2017 ACC/AHA definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction, defined as FMD < 7.0% (OR, 1.15; 95% CI, 0.98-1.35; P = 0.09). Of 4747 subjects (3727 men; mean age: 45.1 ± 10.8 years), 314 subjects (6.6%) had isolated diastolic hypertension according to the ESC/ESH definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction after adjusting for age and sex (OR, 1.04; 95% CI, 0.82-1.32; P = 0.76). Isolated diastolic hypertension was not associated with endothelial dysfunction in individuals who were not treated with antihypertensive drugs regardless of the major hypertension guideline definition used.
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31
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Zhang S, Liu S, Jiao Y, Zheng L, Sun Y, Sun Z. Association of isolated diastolic hypertension based on different guideline definitions with incident cardiovascular risk in a Chinese rural cohort. J Clin Hypertens (Greenwich) 2021; 24:18-25. [PMID: 34913260 PMCID: PMC8783363 DOI: 10.1111/jch.14349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline lowered the threshold (systolic blood pressure [SBP] <130 mm Hg and diastolic blood pressure [DBP] ≥80 mm Hg) for isolated diastolic hypertension (IDH), whereas the 2018 Chinese guideline still recommends the old threshold (SBP <140 mm Hg and DBP ≥90 mm Hg). This study aimed to investigate the association between IDH, as defined by both guidelines, and the risk of incident cardiovascular disease (CVD) in rural areas of northeast China. This prospective study included participants whose baseline data were collected between 2004 and 2006. The exclusion criteria were baseline CVD, incomplete data, and systolic hypertension. The primary end point was incident CVD, a composite end point including nonfatal myocardial infarction (MI), nonfatal stroke, and CVD death. Multivariate Cox models were used to evaluate the association of IDH with CVD risk. The authors analyzed 19 688 participants (7140 participants with IDH) according to the ACC/AHA guideline. Compared with normotensive participants, individuals with ACC/AHA‐defined IDH were at a high risk of CVD (HR = 1.177, 95% CI: 1.035–1.339). A similar difference in CVD risk was noted when normotensive participants were compared with those with IDH, determined based on the 2018 Chinese guideline (HR = 1.218, 95% CI: 1.050–1.413). Similar results were found in participants who did not take antihypertensives at baseline. Moreover, IDH defined by either guideline was significantly associated with nonfatal MI. ACC/AHA‐defined IDH was associated with a risk of CVD, implying that blood pressure management should be improved in rural areas of China.
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Affiliation(s)
- Shiru Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Sitong Liu
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Yundi Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Liqiang Zheng
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Yingxian Sun
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
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32
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Kaneko H, Yano Y, Itoh H, Morita K, Kiriyama H, Kamon T, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Nishiyama A, Node K, Bakris G, Miura K, Muntner P, Viera AJ, Oparil S, Lloyd-Jones DM, Yasunaga H, Komuro I. Untreated Hypertension and Subsequent Incidence of Colorectal Cancer: Analysis of a Nationwide Epidemiological Database. J Am Heart Assoc 2021; 10:e022479. [PMID: 34724797 PMCID: PMC8751953 DOI: 10.1161/jaha.121.022479] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Studies of the association of hypertension with incident colorectal cancer (CRC) may have been confounded by including individuals taking antihypertensive medication, at high risk for CRC (ie, colorectal polyps and inflammatory bowel disease), or with shared risk factors (eg, obesity and diabetes). We assessed whether adults with untreated hypertension are at higher risk for incident CRC compared with those with normal blood pressure (BP), and whether any association is evident among individuals without obesity or metabolic abnormalities. Methods and Results Analyses were conducted using a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018 (n=2 220 112; mean age, 44.1±11.0 years; 58.4% men). Participants who were taking antihypertensive medications or had a history of CRC, colorectal polyps, or inflammatory bowel disease were excluded. Each participant was categorized as having normal BP (systolic BP [SBP]<120 mm Hg and diastolic BP [DBP] <80 mm Hg, n=1 164 807), elevated BP (SBP 120–129 mm Hg and DBP <80 mm Hg, n=341 273), stage 1 hypertension (SBP 130–139 mm Hg or DBP 80–89 mm Hg, n=466 298), or stage 2 hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg, n=247 734). Over a mean follow‐up of 1112±854 days, 6899 incident CRC diagnoses occurred. After multivariable adjustment, compared with normal BP, hazard ratios for incident CRC were 0.93 (95% CI, 0.85–1.01) for elevated BP, 1.07 (95% CI, 0.99–1.15) for stage 1 hypertension, and 1.17 (95% CI, 1.08–1.28) for stage 2 hypertension. The hazard ratios for incident CRC for each 10‐mm Hg‐higher SBP or DBP were 1.04 (95% CI, 1.02–1.06) and 1.06 (95% CI, 1.03–1.09), respectively. These associations were present among adults who did not have obesity, high waist circumference, diabetes, or dyslipidemia. Conclusions Higher SBP and DBP, and stage 2 hypertension are associated with a higher risk for incident CRC, even among those without shared risk factors for CRC. BP measurement could identify individuals at increased risk for subsequent CRC.
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Affiliation(s)
- Hidehiro Kaneko
- The Department of Cardiovascular Medicine The University of Tokyo Japan.,The Department of Advanced Cardiology The University of Tokyo Japan
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical Trials Yokohama City University Hospital Yokohama Japan.,The Department of Family Medicine and Community Health Duke University Durham NC
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Kojiro Morita
- The Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Japan.,The Department of Health Services Research Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine The University of Tokyo Japan.,The Department of Advanced Cardiology The University of Tokyo Japan
| | - Nobuaki Michihata
- The Department of Health Services Research The University of Tokyo Japan
| | - Taisuke Jo
- The Department of Health Services Research The University of Tokyo Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Akira Nishiyama
- Department of Pharmacology Faculty of Medicine Kagawa University Kagawa Japan
| | - Koichi Node
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - George Bakris
- Department of Medicine University of Chicago Medicine Chicago IL
| | - 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
| | - Paul Muntner
- Department of Epidemiology University of Alabama at Birmingham AL
| | - Anthony J Viera
- The Department of Family Medicine and Community Health Duke University Durham NC
| | - Suzanne Oparil
- Division of Cardiovascular Disease Department of Medicine University of Alabama at Birmingham AL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Hideo Yasunaga
- The Department of Health Services Research Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine The University of Tokyo Japan
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33
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Jimba T, Kaneko H, Yano Y, Itoh H, Yotsumoto H, Seki H, Morita K, Kiriyama H, Kamon T, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Nishiyama A, Node K, Yasunaga H, Komuro I. Relation of the Metabolic Syndrome to Incident Colorectal Cancer in Young Adults Aged 20 to 49 Years. Am J Cardiol 2021; 158:132-138. [PMID: 34481589 DOI: 10.1016/j.amjcard.2021.07.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/28/2022]
Abstract
Onco-cardiology is the emerging field, and the concept of shared risk factor holds an important position in this field. The increasing prevalence of colorectal cancer (CRC) in young adults is a critical epidemiological issue. Although metabolic syndrome, which is a major risk factor for cardiovascular disease, is known to be associated with CRC incidence in middle-aged and elderly individuals, it is unclear whether this association is present in young adults. We assessed whether metabolic syndrome was associated with CRC events in young adults (aged <50 years), and whether the association differed by the definition of metabolic syndrome. We retrospectively analyzed 902,599 adults (20 to 49 years of age) enrolled in the JMDC Claims Database which is a nationwide epidemiological database in Japan between January 2005 and August 2018. Participants who had a history of CRC, colorectal polyps, or inflammatory bowel disease were excluded. Study participants were categorized into 2 groups according to the presence of metabolic syndrome, defined using the Japanese criteria (waist circumference ≥85 cm for men and ≥90 cm for women, and ≥2 metabolic parameters including elevated blood pressure, elevated triglycerides, reduced high-density lipoprotein cholesterol, or elevated fasting plasma glucose). Clinical outcomes were collected between January 2005 and August 2018. The primary outcome was CRC of any stage. Median (interquartile range) age was 41 (37 to 45), and 55.4% were men. Over a median follow-up of 1,008 (429 to 1,833) days, there were 1,884 incidences of CRC. After multivariable adjustment, the hazard ratio (HR) of metabolic syndrome for CRC events was 1.26 (95% confidence interval [CI] = 1.07 to 1.49). Cox regression analysis after multiple imputation for missing values showed that metabolic syndrome was associated with CRC incidence (HR = 1.35, 95% CI = 1.17 to 1.56). Metabolic syndrome was also associated with a higher incidence of CRC in individuals with a follow-up period of ≥365 days (HR = 1.33, 95% CI = 1.10 to 1.60). This association was observed when metabolic syndrome was defined according to the International Diabetes Federation criteria (HR = 1.30, 95% CI = 1.09 to 1.55) and the National Cholesterol Education Program Adult Treatment Panel III criteria (HR = 1.39, 95% CI = 1.12 to 1.72). In conclusion, metabolic syndrome was associated with a higher incidence of CRC among individuals aged <50 years. These results could be informative for risk stratification of subsequent CRC among young adults.
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Affiliation(s)
- Takahiro Jimba
- 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
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan; The Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Yotsumoto
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hikari Seki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Kamon
- 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
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, 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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34
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Matsuoka S, Kaneko H, Yano Y, Itoh H, Fukui A, Morita K, Kiriyama H, Kamon T, Fujiu K, Seki H, Michihata N, Jo T, Takeda N, Morita H, Nakamura S, Yokoo T, Nishiyama A, Node K, Yasunaga H, Komuro I. Association Between Blood Pressure Classification Using the 2017 ACC/AHA Blood Pressure Guideline and Retinal Atherosclerosis. Am J Hypertens 2021; 34:1049-1056. [PMID: 34008020 DOI: 10.1093/ajh/hpab074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We aimed to explore the association between the blood pressure (BP) classification defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the prevalence of retinal atherosclerosis. METHODS This study was a retrospective observational cross-sectional analysis using the JMDC Claims Database. We analyzed 280,599 subjects not taking any antihypertensive medications. According to the 2017 ACC/AHA guideline, each subject was categorized as having normal BP (n = 159,524), elevated BP (n = 35,603), stage 1 hypertension (n = 54,795), or stage 2 hypertension (n = 30,677) using the BP value at the initial health checkup. Retinal photographs were assessed according to the Keith-Wagener-Barker system. RESULTS The median age was 46 years, and 50.4% subjects were men. Retinal atherosclerosis, defined as Keith-Wagener-Barker system grade ≥1, was observed in 3.2% in normal BP, 5.2% in elevated BP, 7.7% in stage 1 hypertension, and 18.7% in stage 2 hypertension. Compared with normal BP, elevated BP (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.23-1.38), stage 1 hypertension (OR, 1.71; 95% CI, 1.64-1.79), and stage 2 hypertension (OR, 4.10; 95% CI, 3.93-4.28) were associated with a higher prevalence of retinal atherosclerosis. Among 92,121 subjects without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol consumption, elevated BP (OR, 1.34; 95% CI, 1.19-1.51), stage 1 hypertension (OR, 1.79; 95% CI, 1.61-1.98), and stage 2 hypertension (OR, 4.42; 95% CI, 4.00-4.92) were associated with a higher prevalence of retinal atherosclerosis. This association was observed in all subgroups stratified by age or sex. CONCLUSIONS Our investigation suggests that retinal atherosclerosis could start even in individuals with elevated BP and stage 1 hypertension.
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Affiliation(s)
- Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Cardiology, New Tokyo Hospital, Matsudo, 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
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan
- The Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Morita
- The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Kamon
- 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 Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Hikari Seki
- 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
| | - Sunao Nakamura
- The Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, 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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35
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Itoh H, Kaneko H, Okada A, Yano Y, Morita K, Seki H, Kiriyama H, Kamon T, Fujiu K, Matsuoka S, Nakamura S, Michihata N, Jo T, Takeda N, Morita H, Nishiyama A, Node K, Yasunaga H, Komuro I. Fasting Plasma Glucose and Incident Colorectal Cancer: Analysis of a Nationwide Epidemiological Database. J Clin Endocrinol Metab 2021; 106:e4448-e4458. [PMID: 34378781 DOI: 10.1210/clinem/dgab466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT Although diabetes mellitus (DM) was reported to be associated with incident colorectal cancer (CRC), the detailed association between fasting plasma glucose (FPG) and incident CRC has not been fully understood. OBJECTIVE We assessed whether hyperglycemia is associated with a higher risk for CRC. DESIGN Analyses were conducted using the JMDC Claims Database [n = 1 441 311; median age (interquartile range), 46 (40-54) years; 56.6% men). None of the participants were taking antidiabetic medication or had a history of CRC, colorectal polyps, or inflammatory bowel disease. Participants were categorized as normal FPG (FPG level < 100 mg/dL; 1 125 647 individuals), normal-high FPG (FPG level = 100-109 mg/dL; 210 365 individuals), impaired fasting glucose (IFG; FPG level = 110-125 mg/dL; 74 836 individuals), and DM (FPG level ≥ 126 mg/dL; 30 463 individuals). RESULTS Over a mean follow-up of 1137 ± 824 days, 5566 CRC events occurred. After multivariable adjustment, the hazard ratios for CRC events were 1.10 (95% CI 1.03-1.18) for normal-high FPG, 1.24 (95% CI 1.13-1.37) for IFG, and 1.36 (95% CI 1.19-1.55) for DM vs normal FPG. We confirmed this association in sensitivity analyses excluding those with a follow-up of< 365 days and obese participants. CONCLUSION The risk of CRC increased with elevated FPG category. FPG measurements would help to identify people at high-risk for future CRC.
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Affiliation(s)
- Hidetaka Itoh
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, 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
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, University of Tokyo
| | - Hikari Seki
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Kamon
- Department of Cardiovascular 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
| | - Satoshi Matsuoka
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, 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
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, 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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36
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Romero CA, Tabares AH, Orias M. Is Isolated Diastolic Hypertension an Important Phenotype? Curr Cardiol Rep 2021; 23:177. [PMID: 34657205 DOI: 10.1007/s11886-021-01609-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Isolated diastolic hypertension (IDH) is a frequent hypertension phenotype. We review IDH pathophysiology, risk stratification, and therapeutic decisions. RECENT FINDINGS Recent guidelines lowering blood pressure cutoff levels have increased IDH prevalence and likely decreased associated cardiovascular risk. Long-term cardiovascular risk and pharmacological intervention in IDH are controversial. Narrow pulse pressure and other physiological and epidemiological characteristics are shared with a systodiastolic hypertension (SDH) subgroup. We propose that IDH be incorporated into a broader category, predominantly diastolic hypertension (PDH), defined by pulse pressure ≤ 45 mmHg and includes IDH and SDH with a narrow pulse pressure. IDH-PDH is associated with cardiovascular risk in the long term, especially in young patients. Standardization of the IDH definition and population may contribute to future research to understand genetics, pathophysiology, and eventually therapy in this important subgroup of hypertensive patients.
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Affiliation(s)
- Cesar A Romero
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Marcelo Orias
- Section of Nephrology, Yale University, 25 Glenbrook Rd, Stamford, CT, 06902, USA.
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37
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McEvoy JW, Yang WY, Thijs L, Zhang ZY, Melgarejo JD, Boggia J, Hansen TW, Asayama K, Ohkubo T, Dolan E, Stolarz-Skrzypek K, Malyutina S, Casiglia E, Lind L, Filipovský J, Maestre GE, Li Y, Wang JG, Imai Y, Kawecka-Jaszcz K, Sandoya E, Narkiewicz K, O'Brien E, Vanassche T, Staessen JA. Isolated Diastolic Hypertension in the IDACO Study: An Age-Stratified Analysis Using 24-Hour Ambulatory Blood Pressure Measurements. Hypertension 2021; 78:1222-1231. [PMID: 34601965 PMCID: PMC8516806 DOI: 10.1161/hypertensionaha.121.17766] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- John W McEvoy
- National University of Ireland Galway, School of Medicine, and National Institute for Prevention and Cardiovascular Health, Ireland (J.W.M.)
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital (W.-Y.Y.), Shanghai Jiao Tong University School of Medicine, China
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (Z.-Y.Z., L.T., J.D.M., K.A.), University of Leuven, Belgium
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (Z.-Y.Z., L.T., J.D.M., K.A.), University of Leuven, Belgium
| | - Jesus D Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (Z.-Y.Z., L.T., J.D.M., K.A.), University of Leuven, Belgium
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.)
| | - Tine W Hansen
- The Steno Diabetes Center Copenhagen, Gentofte, and Center for Health, Capital Region of Denmark, Copenhagen (T.W.H.)
| | - Kei Asayama
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (Z.-Y.Z., L.T., J.D.M., K.A.), University of Leuven, Belgium.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A., T.O., Y.I.).,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.)
| | - Takayoshi Ohkubo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A., T.O., Y.I.).,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.)
| | - Eamon Dolan
- Stroke and Hypertension Unit, Connolly Hospital, Geriatric Medicine, Dublin, Ireland (E.D.)
| | - Katarzyna Stolarz-Skrzypek
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.S.-S., K.K.-J.)
| | - Sofia Malyutina
- Institute of Internal and Preventive Medicine and Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation (S.M.)
| | | | - Lars Lind
- Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Sweden (L.L.)
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic (J.F.)
| | - Gladys E Maestre
- Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (G.E.M.).,Department of Biomedical Sciences, Division of Neuroscience and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.)
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital (Y.L., J.-G.W.), Shanghai Jiao Tong University School of Medicine, China
| | - Ji-Guang Wang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital (Y.L., J.-G.W.), Shanghai Jiao Tong University School of Medicine, China
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A., T.O., Y.I.)
| | - Kalina Kawecka-Jaszcz
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.S.-S., K.K.-J.)
| | - Edgardo Sandoya
- Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay (E.S.)
| | - Krzysztof Narkiewicz
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.)
| | - Eoin O'Brien
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland (E.O.)
| | - Thomas Vanassche
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (T.V.), University of Leuven, Belgium
| | - Jan A Staessen
- Biomedical Sciences Group, Faculty of Medicine (J.A.S.), University of Leuven, Belgium.,Research Institute Alliance for the Promotion of Preventive Medicine, Mecehelen, Belgium (J.A.S)
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Itoh H, Kaneko H, Fujiu K, Kiriyama H, Morita K, Kamon T, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Risk Factors and Lifestyles in the Development of Atrial Fibrillation Among Individuals Aged 20-39 Years. Am J Cardiol 2021; 155:40-44. [PMID: 34294408 DOI: 10.1016/j.amjcard.2021.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
Epidemiological evidence on the relationship of modifiable risk factors and lifestyles with incident atrial fibrillation (AF) in young adults remains insufficient. We aimed to identify the determinants of AF among young adults using a nationwide epidemiological database. Medical records of 286,876 individuals (20-39 years) without prior history of cardiovascular disease were extracted from the JMDC Claims Database. We analyzed the association of modifiable risk factors with the incidence of AF. The median (interquartile range) age was 34 (29-37) years, and 54.4% were men. After a mean follow-up of 1,017 ± 836 days, 267 individuals (0.1%) developed AF. Multivariable Cox regression analysis demonstrated that high waist circumference, hypertension, cigarette smoking, and poor sleep quality as well as age and sex were associated with increased incidence of AF. Kaplan-Meier curves showed that number of modifiable components including high waist circumference, hypertension, cigarette smoking, and poor sleep quality clearly stratified the risk of AF development (Log rank test, p < 0.001). Age- and sex-adjusted Cox regression analyses showed individuals with one (hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.13-2.18), two (HR 2.03, 95% CI 1.40-2.95), three (HR 3.48, 95% CI 2.19-5.54), and four (HR 10.78, 95% CI 5.26-22.11) components were associated with an increased incidence of AF compared with individuals with no components. In conclusion, high waist circumference, hypertension, cigarette smoking, and poor sleep quality were associated with the development of AF among young adults, suggesting the importance of maintaining these modifiable factors for the primordial prevention of AF in young adults.
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Affiliation(s)
- Hidetaka Itoh
- 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.
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tatsuya Kamon
- 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
| | - 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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Fukui A, Kaneko H, Okada A, Yano Y, Itoh H, Matsuoka S, Morita K, Kiriyama H, Kamon T, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Nakamura S, Nishiyama A, Node K, Yokoo T, Nangaku M, Yasunaga H, Komuro I. Semiquantitative assessed proteinuria and risk of heart failure: Analysis of a nationwide epidemiological database. Nephrol Dial Transplant 2021; 37:1691-1699. [PMID: 34491362 DOI: 10.1093/ndt/gfab248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Heart failure (HF) is increasing in prevalence worldwide. We explored whether adults with trace and positive proteinuria were at a high risk for incident HF compared with those with negative proteinuria using a nationwide epidemiological database. METHODS This is an obserevational cohort study using the JMDC Claims Database collected between 2005 and 2020. This is a population-based sample (n = 1,021,943; median age [interquartile range], 44 [37-52] years; 54.8% men). No participants had a known history of cardiovascular disease. Each participant was categorized into three groups according to the urine dipstick test results: negative proteinuria (n = 902,273), trace proteinuria (n = 89,599), and positive proteinuria (≥1+) (n = 30,071). The primary outcome was HF. The secondary outcomes were myocardial infarction, stroke, and atrial fibrillation. We performed multivariable Cox regression analyses to identify the association between the proteinuria category and incient HF and other cardiovascular disease events. RESULTS Over a mean follow-up of 1,150 ± 920 days, 17,182 incident HF events occurred. After multivariable adjustment, hazard ratios (HRs) for HF events were 1.09 (95% confidence interval [CI], 1.03-1.15) and 1.59 (95% CI, 1.49-1.70) for trace proteinuria and positive proteinuria vs. negative proteinuria, respectively. This association was present irrespective of clinical characteristics. A stepwise increase in the risk of myocardial infarction, stroke, and atrial fibrillation with proteinuria category was also observed. Our primary results were confirmed in participants after multiple imputation for missing values and in those having no medications for hypertension, diabetes mellitus, and dyslipidemia. Discriminative predictive value for HF events improved by adding the results of urine dipstick test to traditional risk factors (net reclassification improvement 0.0497, 95% CI 0.0346-0.0648, p < 0.001). CONCLUSIONS Not only positive proteinuria but also trace proteinuria was associated with a greater incidence of HF in the general population. Semiquantitative assessment of proteinuria would be informative for the risk stratification of HF.
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Affiliation(s)
- Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.,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
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yano
- . YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan.,The Department of Family Medicine and Community Health, Duke University, Durham, NC
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,The Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Kojiro Morita
- The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Kamon
- 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
| | - Sunao Nakamura
- The Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, 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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40
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Ganti V, Carek AM, Jung H, Srivatsa AV, Cherry D, Johnson LN, Inan OT. Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study. JMIR Mhealth Uhealth 2021; 9:e27466. [PMID: 34338646 PMCID: PMC8369375 DOI: 10.2196/27466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/10/2021] [Accepted: 05/10/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Noninvasive and cuffless approaches to monitor blood pressure (BP), in light of their convenience and accuracy, have paved the way toward remote screening and management of hypertension. However, existing noninvasive methodologies, which operate on mechanical, electrical, and optical sensing modalities, have not been thoroughly evaluated in demographically and racially diverse populations. Thus, the potential accuracy of these technologies in populations where they could have the greatest impact has not been sufficiently addressed. This presents challenges in clinical translation due to concerns about perpetuating existing health disparities. OBJECTIVE In this paper, we aim to present findings on the feasibility of a cuffless, wrist-worn, pulse transit time (PTT)-based device for monitoring BP in a diverse population. METHODS We recruited a diverse population through a collaborative effort with a nonprofit organization working with medically underserved areas in Georgia. We used our custom, multimodal, wrist-worn device to measure the PTT through seismocardiography, as the proximal timing reference, and photoplethysmography, as the distal timing reference. In addition, we created a novel data-driven beat-selection algorithm to reduce noise and improve the robustness of the method. We compared the wearable PTT measurements with those from a finger-cuff continuous BP device over the course of several perturbations used to modulate BP. RESULTS Our PTT-based wrist-worn device accurately monitored diastolic blood pressure (DBP) and mean arterial pressure (MAP) in a diverse population (N=44 participants) with a mean absolute difference of 2.90 mm Hg and 3.39 mm Hg for DBP and MAP, respectively, after calibration. Meanwhile, the mean absolute difference of our systolic BP estimation was 5.36 mm Hg, a grade B classification based on the Institute for Electronics and Electrical Engineers standard. We have further demonstrated the ability of our device to capture the commonly observed demographic differences in underlying arterial stiffness. CONCLUSIONS Accurate DBP and MAP estimation, along with grade B systolic BP estimation, using a convenient wearable device can empower users and facilitate remote BP monitoring in medically underserved areas, thus providing widespread hypertension screening and management for health equity.
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Affiliation(s)
- Venu Ganti
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Andrew M Carek
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Hewon Jung
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Adith V Srivatsa
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | | | | | - Omer T Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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41
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Seki H, Kaneko H, Morita H, Itoh H, Morita K, Matsuoka S, Kiriyama H, Kamon T, Fujiu K, Michihata N, Jo T, Takeda N, Yano Y, Nakamura S, Node K, Yasunaga H, Komuro I. Relation of Serum Uric Acid and Cardiovascular Events in Young Adults Aged 20-49 Years. Am J Cardiol 2021; 152:150-157. [PMID: 34140140 DOI: 10.1016/j.amjcard.2021.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 01/22/2023]
Abstract
Serum uric acid (SUA) was reported to be associated with incident cardiovascular disease (CVD). However, the relationship between SUA and CVD among young adults has not been clarified yet. In this study, we aimed to identify the association of medication naïve SUA with incident CVD including myocardial infarction (MI), stroke, heart failure (HF) and atrial fibrillation (AF) using a nationwide epidemiological database. We analyzed 353,613 participants aged 20-49 years, who were not taking UA lowering medications, and had no prevalent history of cardiovascular disease (CVD) using a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018. Median [interquartile range] age was 40 [34-44] years, and 46.9% were men. Over a mean follow-up of 1,176±876 days, 391 (0.1%) incident MI, 1,308 (0.4%) incident stroke, 3,374 (1.0%) incident HF, and 684 (0.2%) incident AF events occurred. Kaplan-Meier curves and the log-rank test showed that there was a significant difference in incident MI, stroke, HF, and AF among the groups based on SUA tertile (all log-rank p< 0.001). Multivariable Cox regression analysis showed that the upper tertile of SUA (SUA ≥ 5.7 mg/dL) was associated with higher incidence of MI (HR 1.45, 95% CI 1.00-2.10), HF (HR 1.13, 95% CI 1.01-1.28), and AF (HR 1.35, 95% CI 1.02-1.78) compared with the first tertile of SUA (SUA < 4.4 mg/dL). SUA as continuous variable was independently associated with incident MI (HR 1.10, 95% CI 1.00-1.20), stroke (HR 1.06, 95% CI 1.00-1.11), HF (HR 1.07, 95% CI 1.03-1.10), and AF (HR 1.11, 95% CI 1.04-1.19). SUA ≥ 7.0 mg/dL was independently associated with incident HF (HR 1.24, 95% CI 1.12-1.38). In conclusion, higher SUA was associated with increased incidence of CVD events in individuals aged< 50 years, suggesting the potential significance of the optimal UA control for the primary CVD prevention even in young adults.
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42
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The association between isolated systolic or diastolic hypertension and cardiovascular risk. J Hypertens 2021; 39:1552-1554. [PMID: 34188001 DOI: 10.1097/hjh.0000000000002857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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43
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Wang MC, Lloyd-Jones DM. Cardiovascular Risk Assessment in Hypertensive Patients. Am J Hypertens 2021; 34:569-577. [PMID: 33503227 DOI: 10.1093/ajh/hpab021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/10/2021] [Accepted: 01/24/2021] [Indexed: 12/21/2022] Open
Abstract
Hypertension is a highly prevalent and causal risk factor for cardiovascular disease (CVD). Quantitative cardiovascular (CV) risk assessment is a new paradigm for stratifying hypertensive patients into actionable groups for clinical management and prevention of CVD. The large heterogeneity in hypertensive patients makes this evaluation complex, but recent advances have made CV risk assessment more feasible. In this review, we first describe the prognostic significance of various levels and temporal patterns of blood pressure (BP). We then discuss CV risk prediction equations and the rationale of taking global risk into account in hypertensive patients. Finally, we review several adjunctive biomarkers that may refine risk assessment in certain patients. We observe that, beyond individual cross-sectional measurements, both short-term and long-term BP patterns are associated with incident CVD; that current CV risk prediction performs well, and its incorporation into hypertension management is associated with potential population benefit; and that adjunctive biomarkers of target organ damage show the most promise in sequential screening strategies that target biomarker measurement to patients in whom the results are most likely to change clinical management. Implementation of quantitative risk assessment for CVD has been facilitated by tools and direct electronic health record integrations that make risk estimates accessible for counseling and shared decision making for CVD prevention. However, it should be noted that treatment does not return an individual to the risk of someone who never develops hypertension, underscoring the need for primordial prevention in addition to continued innovation in risk assessment.
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Affiliation(s)
- Michael C Wang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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44
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Jacobsen AP, Al Rifai M, Arps K, Whelton SP, Budoff MJ, Nasir K, Blaha MJ, Psaty BM, Blumenthal RS, Post WS, McEvoy JW. A cohort study and meta-analysis of isolated diastolic hypertension: searching for a threshold to guide treatment. Eur Heart J 2021; 42:2119-2129. [PMID: 33677498 PMCID: PMC8169158 DOI: 10.1093/eurheartj/ehab111] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 01/01/2023] Open
Abstract
AIMS Whether isolated diastolic hypertension (IDH), as defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline, is associated with cardiovascular disease (CVD) has been disputed. We aimed to further study the associations of IDH with (i) subclinical CVD in the form of coronary artery calcium (CAC), (ii) incident systolic hypertension, and (iii) CVD events. METHODS AND RESULTS We used multivariable-adjusted logistic and Cox regression to test whether IDH by 2017 ACC/AHA criteria (i.e. systolic blood pressure <130 mmHg and diastolic blood pressure ≥80 mmHg) was associated with the above outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA). In a random-effects meta-analysis of the association between IDH and CVD events, we combined the MESA results with those from seven other previously published cohort studies. Among the 5104 MESA participants studied, 7.5% had IDH by the 2017 ACC/AHA criteria. There was no association between IDH and CAC [e.g. adjusted prevalence odds ratio for CAC >0 of 0.88 (95% CI 0.66, 1.17)]. Similarly, while IDH was associated with incident systolic hypertension, there was no statistically significant associations with incident CVD [hazard ratio 1.19 (95% CI 0.77, 1.84)] or death [hazard ratio 0.94 (95% CI 0.65, 1.36)] over 13 years in MESA. In a stratified meta-analysis of eight cohort studies (10 037 843 participants), the 2017 IDH definition was also not consistently associated with CVD and the relative magnitude of any potential association was noted to be numerically small [e.g. depending on inclusion criteria applied in the stratification, the adjusted hazard ratios ranged from 1.04 (95% CI 0.98, 1.10) to 1.09 (95% 1.03, 1.15)]. CONCLUSION The lack of consistent excess in CAC or CVD suggests that emphasis on healthy lifestyle rather than drug therapy is sufficient among the millions of middle-aged or older adults who now meet the 2017 ACC/AHA criteria for IDH, though they require follow-up for incident systolic hypertension. These findings may not extrapolate to adults younger than 40 years, motivating further study in this age group.
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Affiliation(s)
- Alan P Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mahmoud Al Rifai
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Kelly Arps
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington and Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Wendy S Post
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway School of Medicine, Moyola Lane, Newcastle, Galway, H91 FF68, Ireland
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45
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Itoh H, Kaneko H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Metabolically Healthy Obesity and the Risk of Cardiovascular Disease in the General Population - Analysis of a Nationwide Epidemiological Database. Circ J 2021; 85:914-920. [PMID: 33551397 DOI: 10.1253/circj.cj-20-1040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity and metabolic disorders frequently coexist, and both are established risk factors for cardiovascular disease (CVD). Although the phenotype of obesity without metabolic disorders, referred to as metabolically healthy obesity (MHO), is attracting clinical interest, the pathophysiological impact of MHO remains unclear.Methods and Results:Using the Japan Medical Data Center database, we studied 802,288 subjects aged ≥20 years without any metabolic disorders or a prior history of CVD. MHO, defined as obesity (body mass index ≥25 kg/m2) with no metabolic disorders, was observed in 9.8% of the study population. The subjects' mean (±SD) age was 42.8±9.4 years and 44.7% were men. The mean follow-up period was 1,126±849 days. Multivariable Cox regression analysis showed that MHO alone did not significantly increase the risk of any CVD. However, abdominal obesity alone increased the risk of heart failure and atrial fibrillation. Moreover, the coexistence of MHO and abdominal obesity increased the risk of myocardial infarction, angina pectoris, heart failure, and atrial fibrillation. The incidence of stroke was not associated with the presence of MHO and abdominal obesity. CONCLUSIONS Among individuals with no metabolic disorders, MHO alone did not significantly increase the subsequent CVD risk. However, individuals with comorbid MHO and abdominal obesity had a higher risk of myocardial infarction, angina pectoris, heart failure, and atrial fibrillation, suggesting the prognostic importance of abdominal obesity in subjects with MHO.
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Affiliation(s)
- Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo.,Department of Advanced Cardiology, The University of Tokyo
| | | | - Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo.,Department of Advanced Cardiology, The University of Tokyo
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | | | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo
| | - 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
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46
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Kaneko H, Yano Y, Itoh H, Morita K, Kiriyama H, Kamon T, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Node K, Carey RM, Lima JAC, Oparil S, Yasunaga H, Komuro I. Association of Blood Pressure Classification Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline With Risk of Heart Failure and Atrial Fibrillation. Circulation 2021; 143:2244-2253. [PMID: 33886370 DOI: 10.1161/circulationaha.120.052624] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Heart failure (HF) and atrial fibrillation (AF) are growing in prevalence worldwide. Few studies have assessed to what extent stage 1 hypertension in the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines is associated with incident HF and AF. METHODS Analyses were conducted with a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018 (n=2 196 437; mean age, 44.0±10.9 years; 58.4% men). No participants were taking antihypertensive medication or had a known history of cardiovascular disease. Each participant was categorized as having normal BP (systolic BP <120 mm Hg and diastolic BP <80 mm Hg; n=1 155 885), elevated BP (systolic BP 120-129 mm Hg and diastolic BP <80 mm Hg; n=337 390), stage 1 hypertension (systolic BP 130-139 mm Hg or diastolic BP 80-89 mm Hg; n=459 820), or stage 2 hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg; n=243 342). Using Cox proportional hazards models, we identified associations between BP groups and HF/AF events. We also calculated the population attributable fractions to estimate the proportion of HF and AF events that would be preventable if participants with stage 1 and stage 2 hypertension were to have normal BP. RESULTS Over a mean follow-up of 1112±854 days, 28 056 incident HF and 7774 incident AF events occurred. After multivariable adjustment, hazard ratios for HF and AF events were 1.10 (95% CI, 1.05-1.15) and 1.07 (95% CI, 0.99-1.17), respectively, for elevated BP; 1.30 (95% CI, 1.26-1.35) and 1.21 (95% CI, 1.13-1.29), respectively, for stage 1 hypertension; and 2.05 (95% CI, 1.97-2.13) and 1.52 (95% CI, 1.41-1.64), respectively, for stage 2 hypertension versus normal BP. Population attributable fractions for HF associated with stage 1 and stage 2 hypertension were 23.2% (95% CI, 20.3%-26.0%) and 51.2% (95% CI, 49.2%-53.1%), respectively. The population attributable fractions for AF associated with stage 1 and stage 2 hypertension were 17.4% (95% CI, 11.5%-22.9%) and 34.3% (95% CI, 29.1%-39.2%), respectively. CONCLUSIONS Both stage 1 hypertension and stage 2 hypertension were associated with a greater incidence of HF and AF in the general population. The American College of Cardiology/American Heart Association BP classification system may help identify adults at higher risk for HF and AF events.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan.,Department of Advanced Cardiology (H. Kaneko, K.F.), University of Tokyo, Japan
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Japan (Y.Y.).,Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.)
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health (K.M., H.Y.), University of Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M.)
| | - Hiroyuki Kiriyama
- Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan
| | - Tatsuya Kamon
- Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan.,Department of Advanced Cardiology (H. Kaneko, K.F.), University of Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research (N.M., T.J.), University of Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research (N.M., T.J.), University of Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Japan (K.N.)
| | - Robert M Carey
- Department of Medicine, University of Virginia Health System, Charlottesville (R.M.C.)
| | | | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.)
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health (K.M., H.Y.), University of Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan
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Kaneko H, Itoh H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Lipid Profile and Subsequent Cardiovascular Disease among Young Adults Aged < 50 Years. Am J Cardiol 2021; 142:59-65. [PMID: 33301771 DOI: 10.1016/j.amjcard.2020.11.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/23/2022]
Abstract
Epidemiological evidence on the relationship between lipid profile and cardiovascular disease (CVD) events in young adults remains insufficient. Thus, we sought to explore the association of lipid profile with subsequent CVD among young adults. Medical records of 1,451,997 young adults (20 to 49 years old) without prior history of CVD and not taking lipid lowering medications were extracted from the Japan Medical Data Center, a nationwide epidemiological database. We conducted multivariable Cox regression analyses to identify the association between lipid profile and the subsequent risk of CVD and used multiple imputation for missing data on body mass index, waist circumference, hypertension, diabetes mellitus, and cigarette smoking in our database. The mean age was 39.0 ± 7.4 years, and 58.5% were men. After a mean follow-up of 1,148 ± 893 days, myocardial infarction, angina pectoris, stroke, and heart failure developed in 1,638 (0.1%), 15,887 (1.1%), 5,593 (0.4%), and 14,351 (1.0%) subjects, respectively. Multivariable Cox regression analyses including covariates after multiple imputation for missing values demonstrated that LDL-C ≥ 140 mg/dL, HDL-C < 40 mg/dL, and triglycerides ≥ 150 mg/dL were independently associated with the incidence of myocardial infarction, angina pectoris, and heart failure. However, they were not associated with the incidence of stroke. Multivariable Cox regression analyses including the number of abnormal lipid profiles and covariates showed that the incidence of myocardial infarction, angina, and heart failure increased stepwise with the number of abnormal lipid profiles. However, the number of abnormal lipid profiles was not associated with the subsequent risk of stroke. In conclusion, the comprehensive analysis of a nationwide epidemiological database demonstrated a close relationship between lipid profile and subsequent CVD, suggesting the importance of maintaining an optimal lipid profile for the primary prevention of CVD in young generations.
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Kaneko H, Itoh H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Possible association between eating behaviors and cardiovascular disease in the general population: Analysis of a nationwide epidemiological database. Atherosclerosis 2021; 320:79-85. [PMID: 33581389 DOI: 10.1016/j.atherosclerosis.2021.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Epidemiological evidence on the relationship between eating behaviors, including breakfast skipping, late night dinner, and bedtime snacking, and cardiovascular disease (CVD) events among the general population is scarce. We sought to explore the association of eating behaviors with subsequent CVD using a nationwide epidemiological database. METHODS AND RESULTS Medical records of 1,941,125 individuals without prior history of CVD were extracted from the Japan Medical Data Center contracting with more than 60 insurers from multiple regions in Japan, mainly including employed working-age individuals. Skipping breakfast <3 times per week, late night dinner <3 times per week, and bedtime snacking <3 times per week were defined as optimal eating behaviors. Median age was 45 (interquartile range 39-53) years, and 1,138,676 were men. Median follow-up period was 978 (interquartile range 481-1790) days. Among them, 948,805 individuals (48.9%) had optimal eating behaviors, whereas 647,383 individuals (33.4%), 283,017 individuals (14.6%), and 61,920 individuals (3.2%) had single, double, and triple non-optimal eating behaviors, respectively. Individuals with non-optimal eating behaviors were younger and more likely to be men. Obesity and high waist circumference were more commonly observed in those with non-optimal eating behaviors. Multivariable Cox regression analysis showed that, compared with no non-optimal eating behavior, having non-optimal eating behaviors would have higher risk of myocardial infarction, angina pectoris, stroke, and heart failure. However, the dose-response relationship was not clear in the association between the number of non-optimal eating behaviors and incident CVD. Multivariable Cox regression analysis after multiple imputation for missing values also showed the association between non-optimal eating behaviors and incident CVD. CONCLUSIONS Using a nationwide epidemiological database, we found a possible relationship between eating behaviors including skipping breakfast, late night dinner, and bedtime snacking, and subsequent cardiovascular events among the general population, suggesting the potential importance of maintaining optimal eating behaviors for the primordial and primary CVD prevention in the general population.
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Affiliation(s)
- Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Japan.
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Japan
| | - Kojiro Morita
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan; The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
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Kaneko H, Itoh H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Fasting plasma glucose and subsequent cardiovascular disease among young adults: Analysis of a nationwide epidemiological database. Atherosclerosis 2021; 319:35-41. [PMID: 33465660 DOI: 10.1016/j.atherosclerosis.2020.12.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Using a nationwide epidemiological database, we aimed to clarify the association of fasting plasma glucose (FPG) with subsequent cardiovascular disease (CVD) risk among young adults. METHODS AND RESULTS Medical records of 1,180,062 young adults (20-49 years old) without a prior history of CVD and who were not taking antidiabetic medications were extracted from the Japan Medical Data Center. We categorized the study population into four groups: normal, FPG level<100 mg/dL (1,007,747 individuals), normal-high, FPG level of 100-109 mg/dL (126,602 individuals), impaired fasting glucose (IFG), FPG level of 110-125 mg/dL (32,451 individuals), and diabetes mellitus (DM), FPG level ≥126 mg/dL (13,262 individuals). The mean age was 39.7 ± 6.9 years, and 57.0% of the study population were men. Mean follow-up period was 1201 ± 905 days on average. Multivariable Cox regression analysis showed that IFG (hazard ratio [HR]; 1.38) and DM (HR; 2.09) increased the risk of myocardial infarction. Normal-high (HR; 1.11), IFG (HR; 1.18), and DM (HR; 1.59) groups had an elevated angina pectoris risk. DM (HR; 1.31) increased the risk of stroke compared to normal FPG levels. Normal-high levels (HR; 1.10), IFG (HR; 1.22) and DM (HR; 1.58) elevated the risk of heart failure. DM (HR; 1.69) increased the risk of atrial fibrillation. CONCLUSIONS Our analysis of a nationwide epidemiological database demonstrated a close association of the FPG category with subsequent CVD risk. Our results exemplify the importance of optimal FPG maintenance for the primary prevention of CVD in young adults.
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Affiliation(s)
- Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Japan.
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Japan
| | - Kojiro Morita
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan; The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Japan
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50
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Association of Cardiovascular Health Metrics With Subsequent Cardiovascular Disease in Young Adults. J Am Coll Cardiol 2020; 76:2414-2416. [DOI: 10.1016/j.jacc.2020.09.545] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/06/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022]
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