Trends over the last 20 years in the clinical background of young Japanese patients with coronary artery disease

Relationship between the Appearance of Symptoms and Hospital Visits in Childhood Based on Japanese Statistical Data

BACKGROUND

Childhood health problems affect healthy growth. This study aimed to assess the symptoms and diseases requiring hospital visits commonly found in children in Japan and analyze their effects on health status.

METHODS

Anonymized data on 1315 children aged 6-14 years were obtained from a national survey questionnaire. The survey items addressed symptoms, disease names, and hospital visits. Associations between symptoms and other factors were examined by means of a contingency table analysis and logistic regression.

RESULTS

The proportions of responses for health status were compared for each question item; significant differences were found in age group (p < 0.01), subjective symptoms (p < 0.01), hospital visits (p < 0.01), and lifestyle (p < 0.01). The proportion of responses indicating "poor" perceived health status was high among those with subjective symptoms (4.8%) and hospital visits (4.7%). From the logistic regression, significant odds ratios were found for subjective symptoms (2.10, 95% confidence interval (C.I.) 1.15-3.83) and age group (1.98, 95% C.I. 1.05-3.72).

CONCLUSION

Among measures to improve quality of life from childhood, comprehensive health guidance that emphasizes understanding symptoms and includes age and living conditions is important.

Cardiovascular Risk Factors in Young Patients of Coronary Artery Disease: Differences over a Decade

INTRODUCTION

Studies evaluating temporal trends of Coronary artery disease (CAD) in young patients, from the India, are still lacking. The aim of this study was to evaluate temporal differences in risk factors of young patients of CAD over a decade.

METHODS

This is a single centre retrospective study performed in a tertiary care teaching institution in North India. Case records of young patients (≤40 years) with acute coronary syndrome between January 2000 to December 2001 and January 2009 to December 2010 were obtained. Records were sought for active smoking, family history, waist size, blood pressure, hypertension, fasting and postprandial blood sugar and lipid profile for both groups and analyzed using SPSS v.17. For the purpose of the study, p value <0.05 was considered statistically significant.

RESULTS

Medical records of a total of 79 and 83 patients with young CAD (≤40 years) were obtained for 2000-01 and 2009-10 period respectively. An increase in proportion of female patients, hypertension (p=0.004), dysglycemia (p<0.001), family history (p=0.01), metabolic syndrome (p<0.001), low high density lipoprotein (HDL) (p=0.07) and mean waist size (0.03) was noted over the years. Among males, increase in number of dysglycemics (p=0.0002), positive family history (p<0.0001) and mean waist size (0.032) was statistically significant.

CONCLUSION

Over a decade the patients with young CAD in our study, there was an increase in proportion of patients with metabolic syndrome, dysglycemia and low HDL.

Utility of second derivative of the finger photoplethysmogram for the estimation of the risk of coronary heart disease in the general population

BACKGROUND

Increased arterial stiffness has been shown to be associated with coronary heart disease (CHD). However, it remains unclear as to whether the second derivative of the finger photoplethysmogram (SDPTG), a non-invasive method for the assessment of arterial stiffness, is useful for the estimation of risk of CHD in the general population.

METHODS AND RESULTS

The SDPTG in 211 subjects (age: 63+/-15 years, range: 21-91 years, 93 males) was recorded without apparent atherosclerotic disorders from a community. The relationship between the SDPTG indices (b/a and d/a) and coronary risk factors (n=211) or the Framingham risk score (n=158, age: 60+/-12 years, range: 30-74 years, 63 males) were analyzed. The SDPTG indices significantly correlated with the Framingham risk score in both genders (b/a; r(male) =0.43, r(female) =0.54 and d/a; r(male) =-0.38, r(female) =-0.58), as well as several coronary risk factors. In the receiver operating characteristics curve analyses, the b/a discriminated high-risk subjects for CHD, who were in the highest quintile of the Framingham risk score in each gender, with a sensitivity and specificity of 0.85 and 0.58 in males and 0.83 and 0.72 in females, respectively.

CONCLUSIONS

These results suggest that the SDPTG is useful for the estimation of risk of CHD in the general population.

Low serum ferritin levels as a clue to colonic cancer detection in two patients with coronary artery disease: a case report

We diagnosed colonic cancer using low serum ferritin levels as a clue in two patients with cardiac or cardiopulmonary disease. In the course of the follow-up, the serum ferritin levels decreased to less than 18 ng/mL without significant appearance of iron-deficiency anemia. One patient showed positive immunological fecal occult blood test results whereas the other not. Both patients rejected further colonoscopy because of their concern for stress in relation to their cardiac or cardiopulmonary diseases, but instead agreed to positron emission computed tomography (PET) using a F-18 deoxyglucose at their own expense. In both patients, PET documented abnormal tracer accumulation in the colon. From the results of PET imaging, they eventually agreed to colonoscopy. A colonic adenocarcinoma was detected at the site of the positive PET finding in each patient. Both patients underwent curative resection of the cancer. The detection of the levels of serum ferritin may be available for the screening colonic cancer in patients declining colonoscopic examination.

Valsartan Cardio-Renal Protection in Patients Undergoing Coronary Angiography Complicated With Chronic Renal Insufficiency (VAL-CARP) Trial Rationale and Design

BACKGROUND

Despite an increase in the frequency of coronary angiography (CAG) in Japan, the exact incidence of contrast-induced nephropathy (CIN) remains unknown in the Japanese population, especially in patients with chronic renal insufficiency. In addition, the nature of pharmacological interventions that would benefit the patients before or after procedures such as coronary bypass graft (CABG) and percutaneous coronary intervention (PCI) has not been fully investigated.

METHODS

In the trial 500 patients with renal insufficiency (defined as a glomerular filtration rate (GFR) of between 89 and 30 ml . min(-1) . (1.73 m(-2)) following CAG will be randomly assigned to receive either valsartan, an angiotensin receptor blocker or angiotensin converting enzyme (ACE) inhibitor plus valsartan.1 The primary end-point is a change in the GFR of patients, which will be followed up for 3 years, including following CABG surgery or PCI. The incidence of cardiac events as well as the adverse effects of pharmacological intervention will be evaluated. In addition, the incidence of renal artery stenosis at the time of CAG will be reported also; however, the patients with renal artery stenosis will be excluded from the present study.

CONCLUSION

The present study will provide data on: 1) the exact incidence and course of renal function of CIN after CAG; and 2) the comparative therapeutic benefit of pharmacological intervention with valsartan alone or with valsartan and an ACE inhibitor in combination in patients with coexisting coronary artery diseases and chronic renal insufficiency, regardless of whether they receive CABG or PCI. In addition to these studies, an estimate of the incidence of renal artery stenosis in these patients will be demonstrated.

Relation of Obesity to Acute Myocardial Infarction in Japanese Patients Differences in Gender and Age

BACKGROUND

It remains uncertain whether obesity is an independent risk factor for coronary heart disease in young adults, as well as adults, in Japan.

METHODS AND RESULTS

In the present study, 1,260 cases of acute myocardial infarction (AMI) and 3,775 community controls were recruited from the AMI-Kyoto Multi-Center Risk Study and Kyoto Citizen's Health and Nutrition Study, respectively. Obesity and other risk factors were retrospectively examined between cases and controls in each subgroup of young males (20-40 years), middle-aged males or females (40-60 years), older males or females (60-80 years), and very old males or females (80-100 years). In young, middle-aged, and older males, as well as in older females, cases had a higher body mass index (BMI) than controls. In young males, as well as in middle-aged and older females, cases had a higher prevalence of smoking than controls. Except for very old males, the prevalences of hypercholesterolemia, hypertension, and diabetes mellitus were higher in each subgroup of cases than in controls. Multivariate logistic regression analysis revealed that obesity (BMI >or=25) was an independent risk for AMI in young and middle-aged males, but not in females, whereas smoking was an independent risk for AMI in middle-aged and older females as well as in older males.

CONCLUSIONS

Obesity is significantly associated with AMI, independent of the classic coronary risk factors, in young and middle-aged males. These findings support the current emphasis on controlling obesity to prevent coronary events in young Japanese male adults.

Medium-Term Prognosis of Young Japanese Adults Having Acute Myocardial Infarction

BACKGROUND

Data on the medium- and long-term prognosis of young Japanese patients with acute myocardial infarction (AMI) are still lacking.

METHODS AND RESULTS

In the present study, 1,458 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2003. Of these, clinical characteristics and medium-term prognosis were retrospectively compared in 21 young patients < 40 years (young group), and 190 non-young patients 60-70 years old (non-young group) who could be followed after hospital discharge. The young group was all male and had higher prevalence of current smoking and greater body mass index, but previous myocardial infarction (MI) and hypertension were more prevalent in the non-young group. The young group had a higher prevalence of single-vessel disease and a lesser incidence of left circumflex coronary artery as the culprit lesion. The acquisition rates of Thrombolysis In Myocardial Infarction 3 flow after primary percutaneous coronary intervention did not differ between the 2 groups, but the data of maximal creatine kinase was significantly higher in the young group. During the follow-up period (average 2.42 years for young, 2.37 years for non-young), survival and event-free survival rates and incidence of major adverse cardiac events (MACE) did not differ between the 2 groups. The predictor of MACE during follow-up period was the presence of multivessel disease in the young group, whereas the presence of multivessel disease, history of previous MI and longer hospitalization were the predictors of MACE in the non-young group.

CONCLUSIONS

These results suggest that the medium-term prognosis in young AMI patients is comparable to that of non-young AMI patients in Japan.

Risk factors and the incidence of coronary artery disease in young middle-aged Japanese men: results from a 10-year cohort study

OBJECTIVE

The objective of this study was to elucidate the relationship between risk factors and the coronary artery disease (CAD) in young middle-aged Japanese men.

METHODS

A cohort study of 2,764 young middle-aged Japanese men aged 3544 (mean+/-SD: 42.3+/-2.5) years based on a 10-year followup to identify the risk factors for the occurrence of CAD was conducted. There were 35 cases of CAD during the follow up; 25 myocardial infarctions and 10 angina pectoris. The Cox Proportional hazard model was used to identify the independent risk factors for CAD. Adjustment was made for variables including age, body mass index, smoking habit, systolic blood pressure, total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), fasting plasma glucose (FPG), and triglyceride.

RESULTS

TC, low HDLC, and FPG were identified as significant independent risk factors for CAD. Adjusted hazard ratio (HR) of a high level of TC> or = 220 (mg/dl) for CAD was 5.46 (95% confidence interval (CI): 1.9617.51) and that of a high level of HDLC<50(mg/dl) was 9.01 (95%CI: 1.1372.17), and a high level of FPG> or = 110 (mg/dl) was 2.94 (95%CI: 1.228.23). Considering the combination of these risk factors, adjusted HR for CAD of the subjects who had 2 risk factors was 8.37 (95%CI: 2.2131.65).

CONCLUSIONS

Using the database of young middle-aged Japanese men, TC, low HDLC, and FPG were found to be important risk factors for CAD, and the combination of these risk factors was associated with CAD.

Characteristics of Metabolic and Lifestyle Risk Factors in Young Japanese Patients With Coronary Heart Disease A Comparison With Older Patients

Coronary heart disease (CHD) is recognized as a lifestyle-related disease and is the second leading cause of death in Japan. However, the cardiac risk factor profile of young patients with CHD has not been clarified in suburban areas of Japan. Our study aimed to determine metabolic and lifestyle risk factors in young patients and compare them with older patients living in suburban areas of Nagano Prefecture. A multicenter study was conducted in 86 young (aged less than 40 years) and 91 older (aged 50 years and over) patients diagnosed with CHD from 1992 to 2002. There was a strong association between obesity and the occurrence of CHD events in young patients (odds ratio = 3.61, P = 0.006). Lifestyle in the young patients was characterized by a lack of physical activity and regular physical activity was found to decrease the risk of the CHD events in these patients (odds ratio = 0.31, P = 0.030). In older patients, hypertension was identified as an independent risk factor for CHD events. The results of the present study have demonstrated that obesity and a lack of regular physical exercise are independent risk factors for CHD events in younger patients. Thus, the data may be useful for the effective screening of high-risk individuals and the development of educational programs for the prevention of CHD, especially in younger Japanese.

Single high-dose intravenous immunoglobulin therapy for kawasaki disease increases plasma viscosity

BACKGROUND

Intravenous immunoglobulin therapy, widely used for various autoimmune and systemic inflammatory diseases including Kawasaki disease (KD), is occasionally associated with thromboembolic adverse effects caused by an abrupt increase in blood viscosity. Scarce information is available, however, regarding the effect of single high-dose immunoglobulin therapy for KD on blood viscosity.

METHODS AND RESULTS

Eleven boys and 5 girls (mean age: 2.1 years) with acute-phase KD underwent single high-dose immunoglobulin therapy. Plasma viscosity before the treatment was 1.18 centipoises (SD = 0.06), but it significantly rose to 1.34 centipoises (SD = 0.06) (p < 0.001). Multiple regression analysis revealed that, among various factors including hematocrit, plasma concentrations of total protein, immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM), only plasma IgG concentration was included in the model to explain plasma viscosity (R2 = 0.59, p < 0.001).

CONCLUSIONS

Single high-dose regimen for acute-phase KD increases blood viscosity and therefore might increase the risk of thromboembolism.

Leg fat percentage correlates negatively with coronary atherosclerosis

BACKGROUND

Visceral fat is related to coronary atherosclerosis, but little is known about the relation between coronary atherosclerosis and percent body fat accumulated in different parts of the body.

METHODS AND RESULTS

The subjects were 100 consecutive patients with demonstrated electrocardiographic ischemic changes. Coronary atherosclerosis was assessed using Gensini's coronary score (CS), and for body fat distribution dual energy X-ray absorptiometry was used. The parameters measured were serum lipid concentrations, body weight, body mass index, percent total fat, trunk fat percent, arm fat percent and leg fat percent. Trunk fat percent correlated significantly with CS (p<0.01), and concentrations of low-density lipoprotein cholesterol (LDL-C) (p<0.01) and very low-density lipoprotein cholesterol (VLDL-C) (p<0.05) in men and women. Leg fat percent correlated negatively with CS in both men and women (p<0.01 for each). Concentrations of both LDL-C and VLDL-C correlated positively with CS in both men and women (p<0.01).

CONCLUSION

There is a difference between the effect of body fat in the legs and the trunk that suggests leg fat has an anti-atherosclerotic effect and a negative correlation with CS, and conversely, that trunk fat has a pro-atherosclerotic effect and correlates positively with CS.

Efficacy of Colestimide Coadministered With Atorvastatin in Japanese Patients With Heterozygous Familial Hypercholesterolemia (FH)

BACKGROUND

Colestimide, a 2-methylimidazole-epichlorohydrin polymer, is a new bile-acid-sequestering resin, that is 4-fold as powerful at lowering low-density lipoprotein cholesterol (LDL-C) as the conventional resin (cholestyramine). Moreover, colestimide has excellent patient compliance because it is available in tablet form.

METHODS AND RESULTS

The clinical efficacy of colestimide coadministered with atorvastatin on lipid and apolipoprotein concentrations was examined in 15 patients (M/F=10/5, mean+/-SE age=54+/-9 years) with heterozygous familial hypercholesterolemia (FH). After a period of wash-out of any lipid-lowering drugs, atorvastatin (20-40 mg) was administered to patients for at least 8 weeks, and then 3 g of colestimide was administered for a further 8 weeks. Total and LDL-C significantly (<0.0001) decreased by 35% from 361 to 233 mg/dl and 41% from 274 to 161 mg/dl, respectively. Addition of colestimide caused a further significant 12% and 20% reduction, respectively, from the initial values to 205 and 129 mg/dl, respectively. Colestimide was also effective in reducing serum LDL-C concentrations in heterozygous FH patients with hypertriglyceridemia (triglycerides>or=150 mg/dl).

CONCLUSIONS

When monotherapy with atorvastatin is insufficient to treat severely hypercholesterolemic patients, such as those with heterozygous FH, colestimide acts to reinforce the action of statins.

Seasonal Difference in Onset of Coronary Heart Disease in Young Japanese Patients A Comparison With Older Patients

BACKGROUND

The aim of the present multicenter study was to investigate whether there is a seasonal difference in the onset of coronary heart disease (CHD) in young patients compared with older patients living in Nagano Prefecture, Japan.

METHODS AND RESULTS

The study group comprised 101 young (aged < or = 40 years) and 94 older (aged > or =50 years) patients diagnosed with CHD from 1992 to 2002. In young patients, the prevalence of the onset of CHD events was significantly higher from June to September than from December to March (odds ratio =2.23, p=0.035). Obesity was found in 56%, hypertension in 29%, dyslipidemia in 54%, diabetes in 24%, smoking history in 82%, and habitual physical activity in 13% in young patients. There was a trend for an association between the presence of acute myocardial infarction (p=0.082) and history of smoking and the onset of CHD events during the summer months in young patients (p=0.077).

CONCLUSIONS

There is a seasonal difference in the onset of CHD events, with an increase in the prevalence during the summer months in young patients. The data may provide insights into preventive approaches to CHD in the young population.

Acute Myocardial Infarction in Young Japanese Adults Clinical Manifestations and In-Hospital Outcome

BACKGROUND

The prevalence and clinical manifestations of acute myocardial infarction (AMI) in young patients in Japan have not been fully investigated.

METHODS AND RESULTS

In the present study, 1651 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and June 2004. Of these, the clinical background, risk factors, angiographic findings, acute results of primary percutaneous coronary intervention (PCI) and in-hospital outcomes for 27 young patients <40 (young group), and 338 non-young patients 60<or=, <70 years old (non-young group) were retrospectively compared. The young AMI patients were all male. Current smoking, hypercholesterolemia and family history were the most common risk factors in young patients, while hypertension and diabetes mellitus were more prevalent in non-young patients. Young patients had a higher prevalence of single-vessel disease and a lesser incidence of left circumflex coronary artery as a culprit lesion. The young group had high acquisition rates of Thrombolysis In Myocardial Infarction 3 flow just after primary PCI (95.8%) and no in-hospital deaths, which was not significantly different from the non-young group.

CONCLUSIONS

These results suggest that young AMI patients have different clinical characteristics from those in non-young AMI patients, and acute results of primary PCI and in-hospital prognosis in young AMI patients are comparable to those in non-young AMI patients in Japan.