Low-risk profile for cardiovascular disease and mortality in Japanese

Obesity and hypertension from a public health perspective in a small remote island of Okinawa, Japan

This study investigated the relationship between obesity and hypertension from a public health perspective in a small remote island of Okinawa where obesity is prevalent. A cross-sectional study was conducted in 456 residents aged ≥18 years in Yonaguni island who underwent an annual health check-up and the Yonaguni dietary survey in 2022. Each participant responded to our original questionnaire and provided further dietary survey data via the Yonaguni municipal government. The odds ratio for hypertension was calculated in the obese group, using a logistic regression model with the non-obese group serving as the reference. Hypertension was defined as a systolic blood pressure ≥140 mmHg, a diastolic blood pressure ≥90 mmHg measured on an automated sphygmomanometer, and/or taking anti-hypertensive agents, while obesity was defined as a body mass index ≥25 kg/m2. The proportion of hypertension associated with obesity among all hypertensive subjects was calculated. The prevalence of obesity and hypertension was 54.3% and 49.0% in the 208 male subjects and 32.3% and 43.6% in the 248 female subjects, respectively. The odds ratio for hypertension in the obese group was 3.73 (95% confidence interval, 1.93-7.20) for men and 4.13 (2.06-8.29) for women after adjusting for age, alcohol drinking habit, behavior for lowering salt intake, and smoking habit. Hypertension in 49.5% (95% confidence interval, 29.4%-63.9%) of males and 37.9% (22.6%-50.2%) of females was associated with obesity in this island. Some areas of Japan could be urgently required to address obesity for preventing cardiovascular disease. A community-based, cross-sectional study in 456 residents aged ≥18 years in Yonaguni island, Okinawa prefecture, Japan.

The Influence of the Japanese Nationwide Cardiovascular Prevention System Health Guidance on Smoking Cessation Among Smokers: A Propensity Score Matching Analysis

Aim: We investigated whether 2 types of personalized health guidance (repeated and single counseling) in the Japanese nationwide cardiovascular prevention system promoted smoking cessation among smokers.

Methods: The study included 47,745 Japanese smokers aged 40 to 74 years classified into 2 personalized health guidance schemes. After a 1-year follow-up, we compared the rates of smoking cessation between individuals who had received counseling (“supported”) and those who had not received counseling (“unsupported”). Using propensity score matching analysis, we estimated the average treatment effect (ATE) of each approach on smoking cessation after balancing out the characteristics between the supported and unsupported groups. The propensity score regression model included age, medical insurance type, weight gain since the age of 20 years, exercise, eating habits, alcohol intake, quality of sleep, readiness to modify lifestyle, willingness to receive support, and body mass index.

Results: In the repeated counseling scheme, the age-adjusted rates of smoking cessation in the supported and unsupported groups were 8.8% and 6.3% for males, and 9.8% and 9.1% for females respectively. In the single counseling scheme, the corresponding rates were 8.4% and 7.3% for supported and unsupported males, and 11.0% and 11.7% for supported and unsupported females respectively. The ATE of repeated counseling was + 2.64% (95% confidence interval: + 1.51% to + 3.77%) for males and + 3.11% (−1.85% to +8.07%) for females. The ATE of single counseling was +0.61% (−1.17% to +2.38%) for males and −1.06% (−5.96% to +3.85%) for females.

Conclusions: In the Japanese cardiovascular prevention system, repeated counseling may promote smoking cessation among male smokers.

Independent Prognostic Value of Single and Multiple Non-Specific 12-Lead Electrocardiographic Findings for Long-Term Cardiovascular Outcomes: A Prospective Cohort Study

Aims

The long-term prognostic effect of non-specific 12-lead electrocardiogram findings is unknown. We aimed to evaluate the cumulative prognostic impact of axial, structural, and repolarization categorical abnormalities on cardiovascular death, independent from traditional risk scoring systems such as the Framingham risk score and the NIPPON DATA80 risk chart.

Methods and Results

A total of 16,816 healthy men and women from two prospective, longitudinal cohort studies were evaluated. 3,794 (22.6%) individuals died during a median follow-up of 15 years (range, 2.0–24 years). Hazard ratios for cardiovascular death, all-cause death, coronary death and stroke death were calculated for the cumulative and independent axial, structural, and repolarization categorical abnormalities adjusted for the Framingham risk score and the NIPPON DATA80 risk chart. Individuals with two or more abnormal categories had a higher risk of cardiovascular death after adjustment for Framingham risk score (men: HR 4.27, 95%CI 3.35–5.45; women: HR 4.83, 95%CI 3.76–6.22) and NIPPON DATA80 risk chart (men: HR 2.39, 95%CI 1.87–3.07; women: HR 2.04, 95%CI 1.58–2.64).

Conclusion

Cumulative findings of axial, structural, and repolarization abnormalities are significant predictors of long-term cardiovascular death in asymptomatic, healthy individuals independent of traditional risk stratification systems.

Health factors and risk of all-cause, cardiovascular, and coronary heart disease mortality: findings from the MONICA and HAPIEE studies in Lithuania

Aims

This study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population.

Methods

Data from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45–64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD.

Results

Between 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006–2008 than in 1983–1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5–6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15–0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12–0.97) but not in women (HR 0.38, 95% CI 0.09–1.67).

Conclusions

An inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly among men.

Dietary intervention with cooking instructions and self-monitoring of the diet in free-living hypertensive men

The control of blood pressure (BP) is important in the prevention of cardiovascular diseases. This study was conducted to evaluate the effect of a dietary educational program for free-living, high-normal, and stage 1 or 2 hypertensive men. The participants were volunteers aged 40-75 years who agreed to the intervention. They were divided into two groups: 39 men for the intervention group and 32 men for the control group. BP, urinary sodium and potassium excretion, dietary and lifestyle data, and nonfasting venous blood sample were collected at baseline and after the intervention period. The intervention was designed to decrease sodium level with an emphasis on a decrease in the consumption of salted foods and to increase potassium level with an emphasis on an increase in the consumption of fruit and vegetables through cooking instructions and self-monitoring of the diet. At the baseline, there were no significant differences observed between the groups, except the diastolic BP. In the intervention group, a greater decrease in the urinary sodium-to-potassium excretion ratio was observed, compared with the control group (net difference 0.6, P = .029). The systolic and diastolic BP (mm Hg) decreased in the intervention group (149.0-143.0, P = .073; 93.0-87.0, P = .002), but no changes were observed in the control group (145.0-143.0, P = .231; 84.9-85.3, P = .381). In the intervention group, the urinary sodium-to-potassium excretion ratio was significantly improved by focusing on cooking instructions and self-monitoring of the diet.

Exposure to particulate matter and long-term risk of cardiovascular mortality in Japan: NIPPON DATA80

AIM

It remains uncertain whether chronic exposure to particulate air pollution is associated with increased mortality in Japan because Japan has a different distribution pattern of cardiovascular disease and its risk factors compared to Western countries. We investigated the association between long-term exposure to particulate matter (PM) and cardiovascular mortality risk using a representative Japanese cohort.

METHODS

A total of 7,250 participants aged 30 years and older from 232 districts throughout Japan were followed from 1980 to 2004. We linked the averaged annual concentrations of PM from 1985 to 2004 to each cohort participant who resided in the district at the time of the baseline survey. Study participants were divided into quintiles of average PM concentration. We applied the Cox proportional hazard model adjusting for sex, age, body mass index, blood pressure, total cholesterol, blood glucose, smoking categories, drinking categories, and the municipality population size.

RESULTS

During follow-up, there were 1,716 deaths from all causes; 571 from cardiovascular disease, 116 from coronary heart disease, and 250 from stroke. Hazard ratios were not different among the quintiles and those for trend per 10 µg/m3 increase in annual PM concentration were 0.98 (95% confidence interval, 0.92-1.04) for all-cause mortality and 0.90 (95% confidence interval, 0.81-1.00) for cardiovascular mortality.

CONCLUSION

Long-term exposure to PM was not associated with increased cardiovascular mortality risk in this population-based cohort in Japan.

Attributable fractions of risk factors for cardiovascular diseases

Background

Cardiovascular disease (CVD) is a leading cause of death in Japan. To reduce the threat of CVD, it is important to identify its major risk factors. The population attributable fraction (PAF) is calculated from the prevalence and relative risk of risk factors and can be used to estimate the burden of these factors with respect to CVD. We analyzed the findings from several prospective studies to determine the PAFs of CVD.

Methods

PAF was calculated as pd × (multiadjusted relative risk − 1)/multiadjusted relative risk, where pd is the proportion of patients exposed to that risk factor category, according to data from the Ohsaki Cohort Study, EPOCH-JAPAN, NIPPON DATA80, Miyagi Cohort Study, CARDIA Study, and ARIC Study.

Results

Nonoptimal blood pressure explained 47% and 26% of CVD mortality in middle-aged and elderly Japanese, respectively. Cigarette smoking explained 34% of all-cause mortality in middle-aged men. The combination of hypertension and cigarette smoking explained 57% and 44% of CVD mortality in younger men and women, respectively. Furthermore, the presence of at least 1 nonoptimal risk factor explained most CVD deaths and all-cause deaths.

Conclusions

Established CVD risk factors, especially high blood pressure and cigarette smoking, explained a large proportion of CVD mortality and all-cause mortality. Prevention, early detection, and treatment of these conventional risk factors are required to reduce mortality risk.

Medical expenditures of men with hypertension and/or a smoking habit: a 10-year follow-up study of National Health Insurance in Shiga, Japan

Hypertension and smoking are major causes of disability and death, especially in the Asia-Pacific region, where there is a high prevalence of a combination of these two risk factors. We attempted to measure the medical expenditures of a Japanese male population with hypertension and/or a smoking habit over a 10-year period of follow-up. A cohort study was conducted that investigated the medical expenditures due to a smoking habit and/or hypertension during the decade of the 1990s using existing data on physical status and medical expenditures. The participants included 1708 community-dwelling Japanese men, aged 40-69 years, who were classified into the following four categories: 'neither smoking habit nor hypertension', 'smoking habit alone', 'hypertension alone' or 'both smoking habit and hypertension.' Hypertension was defined as a systolic blood pressure of > or =140 mm Hg, a diastolic blood pressure of > or =90 mm Hg or taking antihypertensive medications. In the study cohort, 24.9% had both a smoking habit and hypertension. During the 10-year follow-up period, participants with a smoking habit alone (18,444 Japanese yen per month), those with hypertension alone (21,252 yen per month) and those with both a smoking habit and hypertension (31,037 yen per month) had increased personal medical expenditures compared with those without a smoking habit and hypertension (17,418 yen per month). Similar differences were observed even after adjustment for other confounding factors (P<0.01). Japanese men with both a smoking habit and hypertension incurred higher medical expenditures compared with those without a smoking habit, hypertension or their combination.