Cardiovascular Disease In Japanese Research Articles

Echocardiographic parameters and cardiovascular disease in Japanese- and US-based CKD cohorts

Japanese and US populations have similar chronic kidney disease prevalence but differing clinical outcomes. A secondary analysis compared cardiovascular outcomes in a Japanese- and a US-based chronic kidney disease cohort and found that the US cohort had markedly worse cardiovascular outcomes. Mediation analysis demonstrated that differences in left ventricular structure and function could explain most of the cardiovascular outcome difference. We examine and contextualize this finding and describe implications for precision nephrology and for population health.

Self-Reported Eczema in Relation with Mortality from Cardiovascular Disease in Japanese: the Japan Collaborative Cohort Study

Aim: Previous studies suggested a positive association between eczema and cardiovascular disease (CVD), probably through enhanced systemic inflammation. However, several studies reported null findings about eczema and CVD, so the evidence is still controversial.Methods: We asked 85,099 participants (35,489 men and 49,610 women), aged 40 to 79 years, without a history of CVD or cancer at baseline between 1988 and 1990, to complete a lifestyle questionnaire, including information eczema frequency (seldom, sometimes or often).Results: During the 6,389,818 person-years of follow-up, there were 1,174 deaths from coronary heart disease (CHD), 979 from heart failure, 366 from cardiac arrhythmia, 2,454 from total stroke, 1,357 from ischemic stroke, 1,013 from hemorrhagic stroke, and 201 from aortic aneurysm or dissection. The multivariable-adjusted model showed that individuals who “sometimes” or “often” had eczema had 0.82 (95%confidence interval (CI): 0.69–0.97) or 1.26 (95%CI: 1.01–1.56) times the risk of mortality from CHD, respectively, compared to those who “seldom” did. Individuals who “often” had 1.30 (95%CI: 1.05–1.61) times the risk of mortality from CHD, compared to those who “seldom or sometimes” did. There was no association of eczema with mortality from other CVD, or no interaction between eczema and sex or age, in relation to any CVD mortality risk.Conclusions: Self-reported frequent eczema was associated with increased risk of mortality from CHD, but not other major CVD, in a Japanese general population. Since steroid usage was not considered, future studies should include it as a potential confounding factor.

Television viewing time and mortality from stroke and coronary artery disease among Japanese men and women -- the Japan Collaborative Cohort Study.

No study has examined the association between television (TV) viewing time and mortality from stroke and coronary artery disease (CAD) in Japanese. A total of 35,959 men and 49,940 women aged 40-79 years without a history of cardiovascular disease (CVD) and cancer were followed from 1988-1990 until 2009. During 19.2 median years of follow-up, there were 2,553 deaths from stroke, 1,206 from CAD and 5,835 from total CVD. Compared with viewing TV for <2 h/day, mortality from stroke, CAD and total CVD were higher for ≥6 h/day of TV viewing. The multivariable hazard ratios (HRs) for ≥6 h/day of TV viewing were 1.15 (95% confidence interval: 0.96-1.37) for stroke, 1.33 (1.03-1.72) for CAD and 1.19 (1.06-1.34) for total CVD. The corresponding HRs for each 1-h/day increment in TV viewing time were 1.01 (0.99-1.04), 1.04 (1.01-1.08) and 1.02 (1.01-1.04), respectively. The excess risk of mortality from CAD and total CVD was somewhat attenuated after further adjustment for potential mediators such as history of hypertension and diabetes: the multivariable HRs for ≥6 h/day of TV viewing were 1.24 (0.96-1.61) and 1.14 (1.02-1.28). The corresponding HRs for each 1-h/day increment in TV viewing time were 1.03 (1.00-1.07) and 1.01 (1.00-1.03). Prolonged TV viewing was associated with a small but significant increase in mortality from CAD and total CVD in Japanese.

Associations of dietary magnesium intake with mortality from cardiovascular disease: The JACC study

The authors sought to investigate the relationship between dietary magnesium intake and mortality from cardiovascular disease in a population-based sample of Asian adults. Reported findings are based on dietary magnesium intake in 58,615 healthy Japanese aged 40–79 years, in the Japan Collaborative Cohort (JACC) Study. Dietary magnesium intake was assessed by a validated food frequency questionnaire administered between 1988 and 1990. During the median 14.7-year follow-up, we documented 2690 deaths from cardiovascular disease, comprising 1227 deaths from strokes and 557 deaths from coronary heart disease. Dietary magnesium intake was inversely associated with mortality from hemorrhagic stroke in men and with mortality from total and ischemic strokes, coronary heart disease, heart failure and total cardiovascular disease in women. The multivariable hazard ratio (95% CI) for the highest vs. the lowest quintiles of magnesium intake after adjustment for cardiovascular risk factor and sodium intake was 0.49 (0.26–0.95), P for trend=0.074 for hemorrhagic stroke in men, 0.68 (0.48–0.96), P for trend=0.010 for total stroke, 0.47 (0.29–0.77), P for trend<0.001 for ischemic stroke, 0.50 (0.30–0.84), P for trend=0.005 for coronary heart disease, 0.50 (0.28–0.87), P for trend=0.002 for heart failure and 0.64 (0.51–0.80), P for trend<0.001 for total cardiovascular disease in women. The adjustment for calcium and potassium intakes attenuated these associations. In conclusion, dietary magnesium intake was associated with reduced mortality from cardiovascular disease in Japanese, especially for women.

Relationship between Periodontal Disease and Cardiovascular Disease in Japanese : Based on the Data of a Health Examination Held in Toyohashi City, Aichi

Relationship between Periodontal Disease and Cardiovascular Disease in Japanese : Based on the Data of a Health Examination Held in Toyohashi City, Aichi

Abstract 8706: Impact of Small Dense Low-Density Lipoproteins Cholesterol on Cardiovascular Disease in an Urban Japanese Cohort: The Suita Study

Aim: Increased plasma low-density lipoprotein cholesterol (LDL-C) concentrations have been shown to be one of the major risk factors for cardiovascular disease (CVD). Clinical evidence also indicates that small dense LDL (sd-LDL) particles are more atherogenic than large buoyant LDL particles. Because there was no easy assay to measure the amount of sd-LDL-C, few studies have addressed the association between sd-LDL-C and CVD. In this study, we hypothesized that higher sd-LDL-C is associated with increased risk for CVD. To this end, we examined the association between sd-LDL-C and CVD in Japanese by using a new kit to measure sd-LDL-C. Methods: We studied 2034 Japanese individuals (30 to 79 years old without stroke or coronary heart disease (CHD)) in the Suita Study, who completed measurement of direct LDL-C and sd-LDL-C by a kit based on the precipitation method with filtration, and then followed for 11.7 years on average. We calculated the Cox proportional adjusted hazard ratios (HRs) of LDL-C, sd-LDL-C, and sd-LDL-C/LDL-C ratio quartiles for incident CAD, stroke, and CVD (CHD + stroke) adjusting for age, sex, body mass index, diabetes, blood pressure category (defined on the basis of the ESH-ESC 2007 criteria), smoking and drinking at baseline. Results: The mean age of this cohort was 59.3 years old and 52.4% was women. The HR of the 4th quartile of sd-LDL-C for the development of CAD was 3.35 (95% confidence intervals: 1.38 to 8.13), which was higher than that in the analysis using LDL-C quartiles. In multivariable adjustment, the HR of the 4th quartile was almost similar. When we used the quartiles of sd-LDL/LDL ratio, increased sd-LDL/LDL ratio was associated with the incidence of CVD, CAD, and stroke. Sex-specific analysis showed that the association of sd-LDL-C with CAD and CVD was statistically significant in men, but not in women. Conclusions: We demonstrated that increased levels of sd-LDL-C are significantly associated with the development of CVD. Our data indicate that sd-LDL-C is a better risk factor for CVD than LDL-C for risk assessment.

Lifestyle and Cardiovascular Disease in Japan

The aim was to give on overview of the profile of cardiovascular disease, vascular pathology and the relationships between lifestyle and cardiovascular disease in Japanese. Compared with the United States and Europe, the higher mortality from stroke and lower mortality from coronary heart disease constitute a unique cardiovascular profile for Japan. A selective review of population-based pathology, trend and prospective cohort studies was performed to clarify the characteristics of cardiovascular disease and vascular pathology, trends in the incidence and mortality of cardiovascular disease, and the relationships between lifestyle and cardiovascular disease among Japanese adults. Since the 1970s, mortality from coronary heart disease as well as stroke has declined substantially in Japan, probably due to a major decline in blood pressure levels and for men a more recent decline in smoking, in spite of an increase in body mass index and total cholesterol levels. However, the decline in mortality was smaller and plateaued in middle-aged men aged 30-49 in the metropolitan cities of Tokyo and Osaka. The incidence of coronary heart disease has increased among middle-aged men residing in the suburbs of Osaka. As for the associations between lifestyle and cardiovascular disease, higher sodium, lower calcium and lower animal protein content in the diet and for men higher alcohol consumption may account for the higher prevalence of hypertension and higher risk of stroke for Japanese than for western populations. On the other hand, lower saturated fat (meat) and higher n3 polyunsaturated fat (fish) in the Japanese diet may contribute to the lower prevalence of hypercholesterolemia and lower risk of coronary heart disease among Japanese. Japan is unique among developed countries in that coronary heart disease mortality has been low and has continued to decline, while stroke mortality has declined substantially. However, a recent trend for coronary heart disease incidence to increase among urban men is a cause for concern as a potential source of future problems for public health and clinical practice in Japan.

Dietary intake of saturated fatty acids and mortality from cardiovascular disease in Japanese: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC) Study

Prospective epidemiologic studies have generated mixed results regarding the association between saturated fatty acid (SFA) intake and risk of ischemic heart disease (IHD) and stroke. These associations have not been extensively studied in Asians. The aim of this study was to test the hypothesis that SFA intake is associated with the risk of cardiovascular disease mortality in Japanese whose average SFA intake is low. The Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) comprised 58,453 Japanese men and women who completed a food-frequency questionnaire. Participants were aged 40-79 y at baseline (1988-1990) and were followed up for 14.1 y. Associations of energy-adjusted SFA intake with mortality from stroke (intraparenchymal and subarachnoid hemorrhages and ischemic stroke) and heart diseases (IHD, cardiac arrest, and heart failure) were examined after adjustment for age, sex, and cardiovascular disease risk and dietary factors. We observed inverse associations of SFA intake with mortality from total stroke [n = 976; multivariable hazard ratio (95% CI) for highest compared with lowest quintiles: 0.69 (0.53, 0.89); P for trend = 0.004], intraparenchymal hemorrhage [n = 224; 0.48 (0.27, 0.85); P for trend = 0.03], and ischemic stroke [n = 321; 0.58 (0.37, 0.90); P for trend = 0.01]. No multivariable-adjusted associations were observed between SFA and mortality from subarachnoid hemorrhage [n = 153; 0.91 (0.46, 1.80); P for trend = 0.47] and heart disease [n = 836; 0.89 (0.68, 1.15); P for trend = 0.59]. SFA intake was inversely associated with mortality from total stroke, including intraparenchymal hemorrhage and ischemic stroke subtypes, in this Japanese cohort.

C-reactive protein levels and risk of mortality from cardiovascular disease in Japanese: The JACC Study

Objects Limited evidence of association between C-reactive protein levels and cardiovascular disease has been produced for Japanese whose median protein levels are low by western standards. Methods We conducted a nested case-control study as part of the Japan Collaborative Cohort Study for evaluation of cancer risk (JACC Study). A total of 39,242 subjects 40–79 years of age provided serum samples at baseline between 1988 and 1990. During the 13-year follow-up, there were 525 deaths from total strokes (ICD10: I60–I69), 209 coronary heart diseases (I20–I25) and 939 total cardiovascular diseases (I00–I99). The control subjects were matched for sex, age, area of residence and year of serum storage, and analyses were conducted after further adjustment for cardiovascular risk factors. Serum high-sensitivity C-reactive protein (hs-CRP) levels were measured with ultra-sensitive latex-enhanced immunoassay. Results Median hs-CRP levels for controls were 0.40 mg/L for men and 0.41 mg/L for women. Hs-CRP levels were positively associated with risks of mortality from stroke, coronary heart disease, and total cardiovascular disease for men. The respective multivariable odds ratios (OR 95% CI) for the highest (≥0.85 mg/L) vs. lowest (<0.19 mg/L) quartiles of hs-CRP for men were 1.60 (0.90–2.85), 3.68 (1.02–13.3), and 2.31 (1.49–3.59). For women, positive associations with hs-CRP levels were weaker, reaching statistical significance only for total cardiovascular disease: OR = 1.69 (1.06–2.68). The positive association with total cardiovascular disease did not vary according to sex, age, smoking status, or body mass index. Conclusions Higher serum hs-CRP levels were associated with higher mortality from cardiovascular disease in Japanese.

Low-Risk Profile for Cardiovascular Disease and Mortality in Japanese

Some studies focusing on low-risk profiles for cardiovascular disease have been reported in Western countries. Yet, few reports have examined, with substantial longevity, the low-risk profile for cardiovascular disease in the Japanese population. This study examines whether having a favorable risk factor profile yields lower all-cause mortality and whether the proportion of those with a low-risk profile is larger in the Japanese population. A total of 8,339 men and women aged 30-69 years without a history of cardiovascular diseases for 19 years, who had participated in the 1980 National Survey on Circulatory Disorders after being randomly selected from throughout Japan, were followed. Low risk was defined as having all of the following baseline characteristics: blood pressure (BP) <120/80 mmHg; no antihypertensive medication; serum cholesterol 160-240 mg/dl (4.14-6.22 mmol/L); no history of diabetes; and non-smoker. The long-term mortality of the low-risk group was compared with that of others using the Cox proportional hazard model. The prevalence of low risk was 9.4% of all participants. The multivariate-adjusted hazard ratios for low-risk individuals compared with others were as follows: 0.33 (95% confidence intervals (CI), 0.15-0.74) for cardiovascular disease and 0.63 (95% CI, 0.46-0.88) for all-cause mortality. The most attributable risk factor for all-cause mortality was high BP (>or=120/80 mmHg). Japanese individuals with favorable cardiovascular disease risk profiles had lower mortality from cardiovascular disease and all-causes than those without.

Smoking Cessation and Mortality from Cardiovascular Disease among Japanese Men and Women: The JACC Study

To examine the effect of smoking cessation on cardiovascular disease mortality in Asians, the authors conducted a 10-year prospective cohort study of 94,683 Japanese (41,782 men and 52,901 women) aged 40-79 years who were part of the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). During 941,043 person-years of follow-up between 1989-1990 and 1999, 698 deaths from stroke, 348 from coronary heart disease, and 1,555 from total cardiovascular disease occurred in men and 550, 199, and 1,155, respectively, in women. For men, the multivariate relative risks for current smokers compared with never smokers were 1.39 (95% confidence interval (CI): 1.13, 1.70) for stroke, 2.51 (95% CI: 1.79, 3.51) for coronary heart disease, and 1.60 (95% CI: 1.39, 1.84) for total cardiovascular disease. The respective relative risks for women were 1.65 (95% CI: 1.21, 2.25), 3.35 (95% CI: 2.23, 5.02), and 2.06 (95% CI: 1.69, 2.51), with larger excess risks for persons aged 40-64 years than for older persons. The risk decline after smoking cessation occurred for coronary heart disease and total cardiovascular disease within 2 years and for total stroke after 2-4 years. For each endpoint and in both age subgroups of 40-64 and 65-79 years, most of the benefit of cessation occurred after 10-14 years following cessation. Findings imply the importance of smoking cessation at any age to prevent cardiovascular disease in Japanese.

Association of GNB3 gene with pulse pressure and clustering of risk factors for cardiovascular disease in Japanese

Heterotrimeric guanine nucleotide-binding proteins (G proteins) mediate many pathways including the β-adrenergic signaling pathway. The C825T polymorphism in the gene coding for the β3 subunit of G proteins (GNB3) has been shown to be associated with several phenotypes such as hypertension, obesity, and diabetes mellitus comprising the metabolic syndrome. The GNB3 C825T polymorphism may therefore be associated with many atherosclerosis-related phenotypes. On these grounds, we studied the C825T polymorphism in relation to atherosclerosis-related phenotypes in a large Japanese population. Analyses in general linear models showed that T carriers had a significantly wider pulse pressure ( P=0.0089) as well as a significantly higher systolic blood pressure ( P=0.026). In contrast, analyses in logistic regression models showed that the C825T polymorphism was not significantly associated with each of the four major classical risk factors for cardiovascular and cerebrovascular disease (obesity, hypertension, hypertriglyceridemia, and diabetes mellitus). However, a significantly higher percentage of subjects had none of the four disorders in CC homozygotes than in T carriers ( P=0.026). Thus, the C825T polymorphism was significantly associated with clustering of these four risk factors. Although the effect of the gene on each phenotype appears to be weak, considering the combined impact of the effects of the C825T polymorphism on risk factors, the GNB3 gene may be an important gene for human health.

Plasma Factor VIIa Levels in Relation to Arterial Cardiovascular Disease in Japanese

Plasma Factor VIIa Levels in Relation to Arterial Cardiovascular Disease in Japanese

Possible link between a low prevalence of cardiovascular disease and mild dyslipidaemia: a study in Japanese patients with type 2 diabetes.

In 98 Japanese patients with Type 2 diabetes mellitus, serum total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), free fatty acid (FFA), and apolipoproteins (apo) A-I, A-II, B, C-II, C-III, and E were determined. The data were compared with those in 47 normolipidaemic normal controls. The total cholesterol value of the diabetic patients was also compared to that of a general population (n = 2227). The diabetic patients were separated into those with cardiovascular disease (n = 20) and without it (n = 78) and a comparison of clinical characteristics and dyslipidaemia was also performed. The diabetic patients had slightly but significantly higher FFA, LDL-C, apo B, C-II, C-III, E, and B/A-I, and lower apo A-I and A-II compared to the normal controls. The total cholesterol level of the diabetic patients (5.17 +/- 0.96 mmol-1) was not significantly higher than that of the general population (5.12 +/- 0.91 mmol-1). By multivariate stepwise discriminant analyses, only total cholesterol significantly discriminated the patients with and without cardiovascular disease. In Japanese patients with Type 2 diabetes, a diabetic population with a very low prevalence of cardiovascular disease, high total cholesterol is a risk factor for developing cardiovascular disease. Nevertheless, a markedly low prevalence of cardiovascular disease in Japanese with Type 2 diabetes compared to Caucasian counterparts may partly be due to the mildness of dyslipidaemia.

Physical Activity and its Relationship to Cardiovascular Risk Factors in Rural Japanese Men

Methods of quantifying physical activity in a population-based sample are needed to examine the relation of physical activity to cardiovascular diseases. We examined validity and reproducibility of an interviewer-administered physical activity questionnaire for men aged 40-59 years in a rural Japanese population. Validity was tested by comparing the estimate of physical activity from a 24-hour diary and maximum oxygen uptake from ergometer exercise test for forty-five men. There was no difference in the estimates of energy expenditure between the questionnaire and the 24-hour diary in each job classfication. Significant correlations were obtained between total activity estimated by the questionnaire and the 24-hour diary (r=0.66) and between the total activity and maximum oxygen uptake (r=0.30). Correlation coefficients between the test and retest at 1-2 year interval for 83 men were 0.67 for total activity, 0.62 for activity at work, 0.59 for leisure time activity and 0.24 for other activity. Using this questionnaire, energy expenditure in total physical activity was measured in 539 men aged 40-59 years living in a rural community of Akita, northeast Japan. Greater physical activity was associated with higher serum HDL-cholesterol levels, lower relative weight index. There was no significant association of physical activity with blood pressure levels, serum total cholesterol, cigarette smoking, and alcohol intake. Thus, greater physical activity was not always associated with lower coronary risk factors except for HDL-cholesterol. Prospective studies will be needed to clarify the relation of physical activity with cardiovascular disease in Japanese. J Epidemiol, 1992; 2 : 97-104.