Smoking cessation and COPD mortality among Japanese men and women: The JACC study

journal articl

Blood Pressure and the Risk of Stroke, Cardiovascular Disease, and All-Cause Mortality Among Japanese: The JPHC Study

Background Little is known about the influence of blood pressure (BP) on cardiovascular disease (CVD) outcomes among Asian populations.Methods We examined population attributable fractions (PAFs) and hazard ratios (HRs) associated with BP in relation to stroke and coronary heart disease (CHD) incident and mortality within a cohort of 33,372 Japanese men and women aged 40–69 years, free of prior diagnosis of cancer and CVD. The BP was classified based on modified criteria of the 2003 European Society of Hypertension–European Society of Cardiology guidelines. A total of 943 stroke events, 182 CHD events, 262 stroke deaths, and 120 CHD deaths occurred between the baseline questionnaire (1990–1994) and the end of follow-up in 31 December 2003.Results BP levels were linearly associated with incidence and mortality of CVD in men and women. According to the PAF estimation, the elimination of normal to severe hypertension would prevent 64% of stroke incidence in men and 50% in women; 67% of stroke mortality in men and 29% in women; and 38% of total CVD mortality in men and 36% in women. The PAF estimate for total stroke incidence was the highest for mild hypertension, and lower for moderate to severe hypertension in both sexes.Conclusions The contributions of normal BP, high normal BP, and mild hypertension to the occurrence of stroke events were greater than those made by moderate and severe hypertension, highlighting the importance of primary prevention and of treatment for low-to-moderate degrees of hypertension

High serum total cholesterol levels is a risk factor of ischemic stroke for general Japanese population: The JPHC study

Background:High serum total cholesterol levels represent a risk factor of ischemic stroke in Western countries. However, this association has not been thoroughly investigated in Asian populations where the incidence of stroke is high.Methods:Participants were 11,727 men and 21,742 women aged 40–69 years, all free of cardiovascular disease and cancer at baseline. During the median 12-year follow-up, we documented 612 ischemic stroke (293 lacunar infarction, 107 large-artery occlusive infarctions, and 168 embolic infarctions).Results:Excess risk of ischemic stroke was observed in men with serum total cholesterol levels of ≥6.21 mmol/L than those with the lowest category (<4.65 mmol/L), but not in women. The multivariable hazard ratios (HRs) and 95% confidence interval (95% CI) were 1.63 (1.14–2.35) for men and 1.03 (0.69–1.55) for women. The corresponding HRs of large-artery occlusive infarction were 2.86 (1.31–6.27) for men and 0.75 (0.28–2.01) for women. Serum total cholesterol levels were not associated with risk of lacunar or embolic infarction for either sex.Conclusions:High serum total cholesterol is a risk factor of ischemic stroke, specifically large-artery occlusive infarction for Japanese men

High Sodium Intake Strengthens the Association between Angiotensinogen T174M Polymorphism and Blood Pressure Levels among Lean Men and Women: a Community-Based Study

Evidence on the effect of salt intake on the interaction between angiotensinogen (AGT) T174M polymorphism and high blood pressure is sparse. We therefore conducted a large population-based cross-sectional study of 2,823 men and women aged 30-74 in a Japanese farming community to examine associations between AGT polymorphism and blood pressure levels stratified by age (30-64 and 65-74), body mass index (BMI; median), and salt intake (median) estimated by 24-h urine collection and dietary questionnaire. Our a priori hypothesis is that individuals, particularly younger and non-overweight individuals, with the 174M allele have elevated blood pressure levels in response to higher sodium intake, and thus the association between T174M polymorphism and blood pressure is more evident among individuals with higher sodium intake than those with lower sodium intake. There were no differences in systolic or diastolic blood pressure levels (SBP or DBP) between the TT and TM+MM genotype groups overall. However, the mean difference in DBP between the TM+MM and TT groups was +1.0 mmHg in subjects of younger age (p =0.06), +1.7 mmHg in non-overweight subjects (BMI<23.5 kg/m2, p =0.01), and +2.3 mmHg in younger and non-overweight subjects (p =0.002). Furthermore, among younger and non-overweight subjects, blood pressure differences were larger for those with higher urinary sodium excretion (+3.1 mmHg, p =0.03), those with a higher sodium/potassium excretion ratio (+4.1 mmHg, p =0.007), those with higher present sodium intake score (+3.0 mmHg, p =0.003), and those with higher past sodium intake score (+3.4 mmHg, p <0.001). In conclusion, AGT T174M polymorphism was associated with higher DBP levels in younger and non-overweight Japanese. This association was more evident among subjects with higher sodium intake

Body Mass Index and Weight Change During Adulthood Are Associated With Increased Mortality From Liver Cancer: The JACC Study

Background: We investigated the association of baseline body mass index (BMI) and weight change since age 20 years with liver cancer mortality among Japanese.Methods: The data were obtained from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). A total of 31 018 Japanese men and 41 455 Japanese women aged 40 to 79 years who had no history of cancer were followed from 1988 through 2009.Results: During a median 19-year follow-up, 527 deaths from liver cancer (338 men, 189 women) were documented. There was no association between baseline BMI and liver cancer mortality among men or men with history of liver disease. Men without history of liver disease had multivariable hazard ratios (HR) of 1.95 (95%CI, 1.07–3.54) for BMI less than 18.5 kg/m2 and 1.65 (1.05–2.60) for BMI of 25 kg/m2 or higher, as compared with a BMI of 21.0 to 22.9 kg/m2. BMI was positively associated with liver cancer mortality among women and women with history of liver disease. Weight change since age 20 years was positively associated with liver cancer mortality among women regardless of history of liver disease. Women with history of liver disease had a multivariable HRs of 1.96 (1.05–3.66) for weight gain of 5.0 to 9.9 kg and 2.31 (1.18–4.49) for weight gain of 10 kg or more, as compared with weight change of −4.9 to 4.9 kg.Conclusions: Both underweight (BMI <18.5 kg/m2) and overweight (BMI ≥25 kg/m2) among men without history of liver disease, and weight gain after age 20 (weight change ≥5 kg) among women with history of liver disease, were associated with increased mortality from liver cancer

Ankle-Arm Blood Pressure Index and Cardiovascular Risk Factors in Elderly Japanese Men

journal articl

Relationships between Sleep-Disordered Breathing and Blood Pressure and Excessive Daytime Sleepiness among Truck Drivers

Sleep-disordered breathing is a risk factor for hypertension, cardiovascular disease and accidents in the general population, but little is known about this correlation among professional truck drivers. To examine the relationships of sleep-disordered breathing with blood pressure levels and excessive daytime sleepiness among truck drivers, we conducted a population-based cross-sectional study of 1,313 subjects aged 20−69 years registered in the Japanese Trucking Association. The 3% oxygen desaturation index was selected as an indicator of sleep-disordered breathing, representing the number of desaturation events per hour of recording time in which blood oxygen fell by ≥3% by overnight pulse oximetry. The Epworth Sleepiness Scale was used to estimate excessive daytime sleepiness. There were significant positive associations between the 3% oxygen desaturation index levels and both diastolic blood pressure levels and Epworth Sleepiness Scale scores. The multivariate odds ratio of hypertension was 2.0 (1.1−3.6) for a 3% oxygen desaturation index of ≥15 in reference with a 3% oxygen desaturation index of <5. This association was more evident among those aged ≥40 years and overweight subjects. Further, the multivariate odds ratio of an Epworth Sleepiness Scale of ≥11 was 2.3 (1.1−4.9) for a 3% oxygen desaturation index of ≥15 in reference with a 3% oxygen desaturation index of <5. This association was more evident among those aged ≥40 years. The associations of sleep-disordered breathing severity with diastolic blood pressure levels and excessive daytime sleepiness suggest the need for sleep-disordered breathing screening among truck drivers for prevention of hypertension and potential traffic accidents

Aldosterone Synthase Gene T−344C Polymorphism Sodium and Blood Pressure in a Free-Living Population: A Community-Based Study

journal articl

Impact of specialization in gynecology and obstetrics departments on pregnant women's choice of maternity institutions

In April 2008, specialization in gynecology and obstetrics departments was introduced in the Sennan area of Osaka prefecture in Japan that aimed at solving the problems of regional provisions of obstetrics services (e.g., shortage of obstetricians, overworking of obstetricians, and provision of specialist maternity services for high-risk pregnancies). Under this specialization, the gynecology and obstetrics departments in two city hospitals were combined and reconstructed into two centers, i.e., the gynecological care center in Kaizuka City Hospital and the prenatal care center in Izumisano City Hospital. This paper investigates to what extent and how this specialization affected pregnant women's choices of the prenatal care center and other maternity institutions. We used birth certificate data of 15,927 newborns from the Sennan area between April 1, 2007 and March 30, 2010, for Before and After Analysis to examine changes in pregnant women's choices of maternity institutions before and after the specialization was instituted. Our results indicated that this specialization scheme was, to some extent, successful on the basis of providing maternity services for high-risk pregnancies at the prenatal care center (i.e., Izumisano City Hospital) and having created a positive effect by pregnant women to other facilities in the nearby area