Circulatory Risk In Communities Study Research Articles

Abstract P455: Insulin Resistance, Secretion and Risk of Incident Coronary Heart Disease in Non-diabetic Japanese Population: The Circulatory Risk in Communities Study

Background: Both high insulin resistance and low insulin secretion are the causes of diabetes mellitus. Japanese level of insulin secretion said to be lower than Western people. However, the association between insulin resistance, secretion and risk of coronary heart disease (CHD) or stroke in non-diabetic population remains unknown. Hypothesis: We assessed the hypothesis that each higher insulin resistance and lower insulin secretion is associated with increased risk of CHD even in non-diabetic population. Methods: A prospective study of Japanese subjects aged 40-79 years was undertaken using data collected from 5,639 participants (1,971 men and 3,668 women) who had no past history of cardiovascular disease or diabetes mellitus in cardiovascular risk surveys conducted in three communities of the Circulatory Risk in Communities Study (CIRCS) in 2000 and 2001. Insulin resistance was calculated on the basis of fasting glucose (mg/dL) and insulin levels (μU/mL) according to the homeostasis model assessment (HOMA-r) method: glucose x insulin / 405. The HOMA-beta cell function (HOMA-b) was calculated by using the following formula: 360 x fasting insulin (μU/mL) / (fasting glucose (mg/dL) - 63). Each incidence of CHD and stroke was ascertained by systematic surveillance. The hazard ratios (HRs) of incidence of CHD and 95% confidence intervals (CI) associated with a 1 standard deviation (SD) increase in log(HOMA-r) and in log(HOMA-b) were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazards model. Results: During an average follow up of 9.8-years, 39 incident CHD (including 23 myocardial infarction) and 123 incident stroke occurred. Higher insulin resistance tended to increase risk of CHD or myocardial infarction, but all HRs did not reach statistical significance. The multivariable HRs in log(HOMA-r) for risk of CHD were 1.30(95% CI: 0.23 to 7.42) for men, 2.84(0.60 to 13.56) for women, and 1.56(0.40 to 6.04) for total subjects. The corresponding HRs of myocardial infarction were 3.73(0.31 to 44.87) for men, 2.45(0.46 to 12.98) for women, and 2.71(0.48 to 15.36) for total subjects. Lower insulin secretion associated with risk of CHD or myocardial infarction, and some of HRs reached statistical significance. The multivariable HRs in log(HOMA-b) for risk of CHD were 1.17(0.56 to 2.45) for men, 0.31(0.10 to0.96, p=0.042) for women, and 0.75(0.40 to1.42) for total subjects. The corresponding HRs of myocardial infarction were 0.53(0.18 to1.53) for men, 0.31(0.07 to 1.35) for women, and 0.42(0.18 to1.00, p=0.049) for total subjects. There was no interaction between HOMA-r and HOMA-b. HOMA-r and HOMA-b did not associated with incidence of stroke. Conclusions: Lower insulin secretion may be associated with increased risk of coronary heart disease among non-diabetic Japanese population.

Heavy Alcohol Consumption and Risk of Atrial Fibrillation

Evidence regarding the relationship between different levels of alcohol consumption and the risk of atrial fibrillation (AF) is currently limited in Asian populations. Between 1991 and 1995, a total of 8,602 Japanese men and women aged 30-80 years took part in the first examination of the Circulatory Risk in Communities Study (CIRCS), a population-based cohort study in Japanese communities. An interviewer obtained detailed information on weekly alcohol intake. During the follow-up period, the incidence of AF was ascertained from annual ECG records, the subject's medical history of AF, and cardiovascular disease surveillance. The hazard ratios (HRs) of incident AF and the 95% confidence intervals (CIs) relative to the never-drinking group were calculated with adjustment for potential confounding factors by using the Cox proportional hazard model. During a median follow-up period of 6.4 years, 296 incidents of AF occurred. A higher incidence of AF was observed among participants with an ethanol intake >69g/day, compared with never-drinkers. Compared with the never-drinkers, the multivariable-adjusted HRs (CIs) of past, light (<23g/day), light-moderate (23-46g/day), moderate (46-69g/day), and heavy (>69g/day) drinkers were 1.30 (0.68-2.49), 0.89 (0.60-1.32), 1.19 (0.73-1.95), 1.36 (0.79-2.35), and 2.90 (1.61-5.23), respectively. Heavy alcohol consumption is associated with a higher risk of AF.

Relationship between the ankle-brachial index and the risk of coronary heart disease and stroke: the circulatory risk in communities study.

Patients with peripheral artery disease (PAD) are at a high risk of cardiovascular disease (CVD) among Western populations. However, evidence for an elevated risk in Asian populations is limited. This prospective cohort study examined 939 Japanese men 60-74 years of age at the time of the baseline survey. A total of 115 cases of CVD were detected during a median 9.3 years of follow-up, and the ankle brachial blood pressure index (ABI) functioned as a surrogate measurement of PAD. The age-adjusted risks of coronary heart disease, ischemic stroke and ischemic CVD (coronary heart disease and ischemic stroke) were higher among men in the lowest ABI tertile compared with that observed in the men in the highest tertile (<1.08 vs. >1.17). These associations did not change substantially after adjusting for cardiovascular risk factors. The respective multivariable hazard ratios (HRs, 95% CI) for the three conditions were as follows: 2.48 (1.08-5.71), p for trend=0.03; 1.95 (0.94-4.02), p for trend=0.04; and 2.16 (1.25-3.72), p for trend=0.004. These results did not vary based on a comparison of the three ABI categories: ≤0.90, 0.91-1.10 and >1.10. The multivariable HRs (95% CI) for an ABI ≤0.90 versus >1.10 were as follows: 2.04 (0.67-6.20), p for trend=0.14 for coronary heart disease; 3.39 (1.10-10.5), p for trend=0.006 for ischemic stroke; and 2.61 (1.19-5.76), p for trend=0.003 for ischemic CVD. There were no associations between the ABI and the risk of hemorrhagic stroke. A low ABI is associated with the risk of coronary heart disease, ischemic stroke and ischemic CVD in elderly Japanese men.

An association between central aortic pressure and subclinical organ damage of the heart among a general Japanese cohort: Circulatory Risk in Communities Study (CIRCS)

BackgroundThis study aimed to investigate associations between central aortic pressure (CAP) and subclinical organ damage of the heart amongst the general population. MethodsWe conducted a cross-sectional study in a community-based population, consisting of 3002 men and women aged between 40 and 79 years. The CAP was measured using the HEM-9000AI device, an automated tonometer. Electrocardiograms (ECG) were read according to the Minnesota Code. Subclinical organ damage in the heart was defined as measurable left high amplitude R waves (LHAR), major and minor ST-T abnormalities, and left ventricular hypertrophy (LVH). ResultsAge- and sex-adjusted prevalence of LHAR, major and minor ST-T abnormalities, and LVH was higher for subjects in the highest tertile of CAP levels than those in the lowest tertile. After further adjustments for other cardiovascular risk factors, these associations did not change substantially. The multivariable odds ratios (ORs) (95% CI) of LHAR, major and minor ST-T abnormalities, and LVH for the highest tertile of CAP levels compared to the lowest tertile were 2.7(1.9–3.9), 1.8(1.1–2.9), 1.7(1.3–2.3) and 3.2(1.3–8.1), respectively. The positive associations with LHAR and minor ST-T abnormalities were observed primarily among non-hypertensive subjects. The respective corresponding ORs were 2.8(1.7–4.6) and 1.7(1.2–2.4) for non-hypertensive subjects, and 1.7(0.9–3.3) and 1.1(0.7–1.8) for hypertensive subjects. ConclusionCAP levels were associated with subclinical organ damage of the heart independent of cardiovascular risk factors, and these associations were primarily seen in non-hypertensive subjects.

Adult Height and Body Mass Index in Relation to Risk of Total Stroke and its Subtypes: The Circulatory Risk in Communities Study

Several studies have reported that height and risk of stroke are inversely associated based on the hypothesis that height is a marker of childhood physical condition. However, a limited number of studies have taken account of the effect of current physical condition on the relationship between height and risk of stroke. We conducted a prospective cohort study of 12,222 40- to 69-year-old Japanese patients under systematic surveillance for stroke incidence. Because body mass index (BMI) is regarded as a surrogate marker of current physical condition for cardiovascular risk, we performed a stratified analysis of this risk based on BMI. During the median 17-year follow-up, there were 565 incident strokes (326 ischemic and 186 hemorrhagic strokes) showing an inverse association between height and risk of stroke independent of classical cardiovascular risk factors. Compared with the lowest height group (<159 cm for men and <148 cm for women) as reference, the multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the highest height group (>166 cm for men and >154 cm for women) were 0.70 (95% CI 0.49-1.00; P = .043) for men and 0.44 (95% CI 0.27-0.70; P < .001) for women. When the analysis was restricted to those with BMI <23 kg/m(2), the associations were stronger for both hemorrhagic and ischemic stroke. Height was found to be inversely associated with risk of stroke for middle-aged Japanese men and women, especially with lower BMIs. Our findings suggest that childhood social and physical conditions may contribute to the development of stroke in adulthood because height is a surrogate marker of these conditions.

Abstract P002: Heavy Alcohol Consumption Increases the Risk of Atrial Fibrillation -Circulatory Risk in Communities Study(CIRCS)

Background— Evidence on the relationship of a wide range of alcohol consumption with risk of incident atrial fibrillation has been limited. Methods— Between 1991 and 1995, 8602 Japanese men and women aged 30 to 80 years and free of clinical atrial fibrillation took part in the first examination of the Circulatory Risk in Communities Study(CIRCS)- a population based cohort study of cardiovascular risk factors, cardiovascular disease incidence, and their trends in Japanese communities. In the first examination, we checked a detailed medical history, physical examination, blood and urine examination, and electrocardiogram (ECG). An interviewer obtained histories in detail for weekly alcohol intake. In the follow-up period, incident atrial fibrillations were ascertained by annual ECG record and medical history of treatment of atrial fibrillation. ECGs were coded with the Minnesota Code by trained physician-epidemiologists. Differences in baseline characteristics between atrial fibrillation cases and controls were compared using Student t-tests or chi-squared tests. The hazard ratios (HRs) of incidence of atrial fibrillation and 95% confidence interval (CI) relative to the never-drinking group were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazard model. Results— During an average follow-up of 6.4 years, 290 incident atrial fibrillation occurred. The higher incidence rate of atrial fibrillation was observed among participants with more than 69 g of ethanol drinking per week, compared with less than 69 g of ethanol drinking per week. On the other hand, light to moderate alcohol consumption was not associated with risk of atrial fibrillation. Compared with the never drinking group, the multivariable-adjusted HRs of past, light (&lt;23 g), light moderate (23-46 g), moderate (46-69 g), and heavy (&gt;69 g) drinking groups were 1.20 (95% CI, 0.61-2.35), 0.85 (95% CI, 0.57-1.27), 1.05 (95% CI, 0.63-1.75), 1.34 (95% CI, 0.78-2.32), and 2.92 (95% CI, 1.61-5.28), respectively. Conclusions— Heavy alcohol consumption was associated with the higher risk of atrial fibrillation, whereas there was no association of less than moderate alcohol consumption and atrial fibrillation.

Abstract P215: Trends in Hemorrhagic Stroke in Japan, from 1986 to 2010: Circulatory Risk in Communities Study (CIRCS).

Background: The incidence of hemorrhagic stroke has substantially decreased nearly to a quarter over years from 1960s to 1980s in Japan. However, there is little evidence on the trends after 1980, or whether subtypes of hemorrhagic stroke have decreased. We examined trends in the incidence of hemorrhagic stroke and its subtypes. Hypothesis: Hemorrhagic stroke have decreased after 1980s. For intraparenchymal hemorrhage (IPH), lobar and cerebellar intraparenchymal hemorrhage has not decreased. Methods: All residents aged 30 to 84 years in two communities (Akita and Osaka, census population: 18,998 in 2000) in Japan was surveyed. The incidence of IPH and subarachnoid hemorrhage (SAH) from 1986 to 2010 was ascertained by systematic surveillance of hospital records and confirmed by physicians with CT or MRI images. The implementation rate of CT or MRI has not changed materially over years (78.9~97.4%). IPH was further categorized to lobar and cerebellar IPH, and deep IPH (thalamus, basal ganglia or brainstem). The respective age-adjusted incidence rates per 100,000 person-years were calculated by each 5 years of time periods: 1986-1990, 1991-1995, 1996-2000, 2001-2005, and 2006-2010. Results: Age-adjusted incidence of SAH has decreased in 1996-2000 but increased after 2000. Respective age-adjusted incidence rates (per 100,000 person-years) of SAH for 5 time periods were 46.2, 46.5, 14.5, 23.0, and 23.7 (p for trend=0.23). Age-adjusted incidence of all IPH has decreased from 1986-1990 to 2006-2010. Respective incidence rates of IPH were 56.8, 53.7, 48.7, 29.0, and 26.5 (p for trend=0.01). For the subtypes of IPH, incidence of lobar and cerebellar IPH has not decreased from 1986-1990 to 2006-2010, while it have decreased for deep IPH. Respective incidence rates for lobar and cerebellar IPH were 13.1, 7.6, 16.6, 10.9, and 10.3 (p for trend=0.85) and those of deep IPH were 52.0, 53.1, 49.8, 40.8, and 29.5 (p for trend=0.03). Conclusion: The age-adjusted incidence of IPH after 1980s has decreased over years, although such trend was not clear for SAH. Among IPH, the incidence of lobar and cerebellar IPH has not decreased, while the incidence of deep IPH has decreased.

High-density Lipoprotein Subclasses and Risk of Stroke and its Subtypes in Japanese Population

High-density lipoprotein (HDL) cholesterol is an established protective factor for ischemic stroke. However, the contribution of HDL subclasses to stroke risk and its subtypes is uncertain. A prospective nested case-control study of 40- to 85-year-old Japanese was undertaken using frozen serum samples collected from 5280 men and 7524 women. They participated in cardiovascular risk surveys from 1985 to 1999 (1 community) and 1989 to 1998 (2 communities) under Circulatory Risk in Communities Study. HDL cholesterol subclasses were classified by high-performance liquid chromatography into 3 subgroups: S-HDL (very small or small HDL), M-HDL (medium HDL), and L-HDL (large or very large HDL) cholesterol. One control subject per case was matched by sex, age, community, serum storage year, and fasting status. In 2005, we identified 241 strokes (155 ischemic and 86 hemorrhagic). S-HDL and M-HDL cholesterol levels were inversely associated with total stroke risk, ischemic stroke, specifically lacunar infarction, and hemorrhagic stroke. After adjustment for cardiovascular risk factors, these associations remained statistically significant. Multivariable conditional odds ratios (95% confidence interval) for 1 SD (0.12 mmol/L) increment of S-HDL cholesterol levels were 0.34 (0.23-0.52) for total stroke, 0.38 (0.23-0.63) for ischemic stroke, 0.33 (0.18-0.61) for lacunar infarction, 0.30 (0.14-0.65) for hemorrhagic stroke, and 0.30 (0.12-0.77) for intraparenchymal hemorrhage. The respective multivariable odds ratios for 1SD (0.10 mmol/L) increment of M-HDL cholesterol levels were 0.56 (0.41-0.75), 0.63 (0.45-0.88), 0.59 (0.40-0.87), 0.41 (0.21-0.80), and 0.38 (0.16-0.90). No associations were found between L-HDL cholesterol levels and risk of total stroke and its subtypes. Small- to medium-sized HDL, not large HDL, cholesterol levels were inversely associated with total stroke risk.

The future of preventive medicine: Polypill prescriptions in the context of Plato's physical perspective

The objective was to determine whether non-fasting glucose concentration is a predictor for incident coronary heart disease.We investigated a cohort data of 9,900 40- to 69-year-old residents in four Japanese communities for 1975–1986 baseline surveys of the Circulatory Risk in Communities Study (CIRCS). Non-fasting blood glucose concentrations were available for 7,332 participants. Diabetic type was defined as a glucose level of ≥ 11.1 mmol/L and/or the use of medication for diabetes mellitus.A total of 170 coronary heart disease including 113 myocardial infarctions occurred in non-fasting participants within the median 22-year follow-up period. Multivariable hazard ratios (HRs) of incident coronary heart disease for the participants with diabetic type compared with the normal type were 1.98 (0.84–4.68) for men, 3.39 (1.47–7.81) for women, and 2.47 (1.37–4.46) for total subjects. Corresponding HRs for myocardial infarction were 2.14 (0.83–5.55), 5.70 (2.21–14.67) and 3.17 (1.65–6.10), respectively. Multivariable HRs of incident coronary heart disease per one standard deviation of serum glucose levels were 1.17 (1.02–1.36), 1.19 (1.03–1.38), and 1.19 (1.08–1.32), respectively. The corresponding HRs for myocardial infarction were 1.18 (1.00–1.38), 1.27 (1.07–1.49) and 1.23 (1.10–1.37).Non-fasting glucose concentration, either as diagnosis of diabetic type or as continuous variable, proved to be an independent predictor for incident coronary heart disease in middle-aged general population.

Non-fasting blood glucose and risk of incident coronary heart disease in middle-aged general population: The Circulatory Risk in Communities Study (CIRCS)

ObjectiveThe objective was to determine whether non-fasting glucose concentration is a predictor for incident coronary heart disease. MethodsWe investigated a cohort data of 9,900 40- to 69-year-old residents in four Japanese communities for 1975–1986 baseline surveys of the Circulatory Risk in Communities Study (CIRCS). Non-fasting blood glucose concentrations were available for 7,332 participants. Diabetic type was defined as a glucose level of ≥11.1mmol/L and/or the use of medication for diabetes mellitus. ResultsA total of 170 coronary heart disease including 113 myocardial infarctions occurred in non-fasting participants within the median 22-year follow-up period. Multivariable hazard ratios (HRs) of incident coronary heart disease for the participants with diabetic type compared with the normal type were 1.98 (0.84–4.68) for men, 3.39 (1.47–7.81) for women, and 2.47 (1.37–4.46) for total subjects. Corresponding HRs for myocardial infarction were 2.14 (0.83–5.55), 5.70 (2.21–14.67) and 3.17 (1.65–6.10), respectively. Multivariable HRs of incident coronary heart disease per one standard deviation of serum glucose levels were 1.17 (1.02–1.36), 1.19 (1.03–1.38), and 1.19 (1.08–1.32), respectively. The corresponding HRs for myocardial infarction were 1.18 (1.00–1.38), 1.27 (1.07–1.49) and 1.23 (1.10–1.37). ConclusionNon-fasting glucose concentration, either as diagnosis of diabetic type or as continuous variable, proved to be an independent predictor for incident coronary heart disease in middle-aged general population.

Alkaline Phosphatase and Risk of Stroke Among Japanese: The Circulatory Risk in Communities Study (CIRCS)

Although serum alkaline phosphatase (ALP) levels have been associated with mortality from all-cause and from either ischemic or hemorrhagic stroke, no study has been published of the associations between ALP and the incidence of stroke. We therefore examined the associations of ALP with risk of stroke among Japanese, stratified by drinking status because ALP is known as an enzyme affected by alcohol consumption. We conducted a prospective cohort study of 10,754 Japanese subjects (4098 men and 6656 women) aged 40-69 years and living in 4 communities under systematic surveillance for stroke incidence. During the 16-year follow-up, we documented 264 strokes (164 ischemic strokes and 69 hemorrhagic strokes) for men and 225 strokes (118 ischemic strokes and 89 hemorrhagic strokes) for women. There was a U-shaped association between ALP level and stroke incidence in both men and women, which was confined primarily to nondrinkers. For nondrinkers, higher ALP levels were associated with an elevated risk of ischemic stroke for men and of hemorrhagic stroke for women, whereas lower ALP levels were associated with elevated risks of ischemic and hemorrhagic strokes in both men and women. Our data indicate that not only higher, but also lower, serum ALP level may be a predictor for the risk of stroke in nondrinking men and women.

Abstract P202: The Impact of Snoring with and without Overweight on the Incidence of Hypertension among Japanese General Population

Introduction: Evidence for the longitudinal impact of snoring on incident hypertension in Asians is still limited. The objective of this study was to examine whether the impact of snoring with and without overweight (body mass index ≥25.0 kg/m 2 ) on the incidence of hypertension among Japanese general population. Hypothesis: We assessed the hypothesis that the impact of snoring on incident hypertension among Japanese general population was more evident for non-overweight (body mass index &lt;25.0 kg/m 2 ) subjects probably because overweight is a primary determinant of both snoring and hypertension. Method: A total of 7,482 non-hypertensive persons (2,891 men and 4,591 women) aged 35-79 years from three communities in Japan who participated in the Circulatory Risk in Communities Study (CIRCS) were followed up for 7.9 years. Hazard ratios for the incidence of hypertension were calculated according to snoring (self-administered questionnaire) stratified by body mass index. Results: At baseline, 74 % of men and 59 % of women had sometimes or everyday snoring and 31 % of men and 28 % of women had being overweight. During the 7.9-year follow-up period, 1087 individuals (451 men and 636 women) developed hypertension. The multivariable-adjusted odds ratio (95%confidence interval) of incident hypertension for snoring compared with non-snoring was 1.37 (1.06 to 1.76) for men and 1.32 (1.10 to 1.58) for women. When stratified by body mass index at baseline, the significant association was observed only in non-overweight; the multivariable adjusted odds ratio of incident hypertension with non-overweight was 1.52 (1.12 to 2.04) for men and 1.39 (1.11 to 1.73) for women, and respective odds ratio for snoring with overweight was 1.11 (0.68 to 1.81) for men and 1.14 (0.83 to 1.53) for women compared with non-snoring categories although the interaction was not statistically significant. The population-attributable fraction (PAF) of snoring with non-overweight for incident hypertension was 26 % for men and 17% for women. Conclusions: Snoring may have larger impact on development hypertension among non-overweight Japanese men and women.

Abstract P029: Diabetes Mellitus and Disabling Dementia among Japanese: The Circulatory Risk in Communities Study (CIRCS)

Introduction: The evidence for the relation between diabetes mellitus and risk of dementia in Asian population has been limited. This study investigated the association between diabetes mellitus and risk of dementia in community-based samples of Japanese. Hypothesis: There is an association between diabetes mellitus and risk of disabling dementia Methods: We performed a nested case-control study based on a cohort of about 6,000 Japanese aged 45-69 at baseline between 1984 and 1994. The information of the status of diabetes at baseline was collected for 174 disabling dementia cases incident between 1999 and 2004 and 348 controls matched with cases by age±3, sex and baseline-year. Incident disabling dementia was defined as dependent individuals who had moderate to severe dementia-related behavioral disturbance or cognitive impairment. This criterion was previously validated with 5-cog test. Dementia cases were further classified according to presence of history of stroke. The conditional odds ratio (OR) for dementia was calculated according to the status of (1) glucose intolerance; fasting serum glucose 110-125mg/dl or non-fasting serum glucose 140-199 mg/dl; and (2) diabetes; fasting serum glucose ≥126 mg/dl, non-fasting serum glucose ≥200 mg/dl, and/or the use of glucose-lowering medication or insulin therapy. Variables for multivariable adjustment were body mass index, smoking status, total cholesterol and hypertension status (140≤SBP&lt;160 mmHg, 90≤DBP&lt;95 mmHg for hypertension of grade 1, SBP ≥160 mmHg, DBP ≥95mmHg for hypertension of grade 2 and 3, and the treatment with an antihypertensive drug). Sex-specific analysis was also conducted as subanalysis. Results and Conclusions: Mean follow-up year was 11.4 years. The proportion of men was 32.8% and the prevalence of glucose intolerance and diabetes among controls were 16.7% and 5.8%, respectively. Of dementia cases, 44.8% had history of stroke. Compared with persons with normal glucose level, ORs (95%CI) for glucose intolerance and diabetes were 1.12 (0.68-1.84) and 2.18 (1.13-4.22), and multivariable ORs were 0.98 (0.58-1.65) and 2.04 (1.03-4.03), respectively. For sex stratified analysis, ORs for diabetes were 1.39 (0.45-4.31) for men, and 2.79 (1.20-6.50) for women. The association of diabetes was primarily observed in dementia cases with stroke history [OR=3.19 (1.04-9.82)], but not in those without it [OR=1.78 (0.78-4.07)]. In conclusion, we found an association between diabetes mellitus and risk of disabling dementia. The association was confined to women, and dementia with stroke history.

Abstract P291: Anger Expression and Risk of Stroke Subtypes: The Circulatory Risk in Communities Study (CIRCS)

Background: Previous studies have reported that anger expression style is associated with cardiovascular disease and its risk factors. Epidemiologic data regarding the association between anger expression and risk of stroke have been inconsistent, and few studies have reported the association of anger expression with stroke subtypes. Hypothesis: We assessed the hypothesis that suppressed anger is associated with increased risk of stroke, and the associations vary by stroke subtype. Methods: A prospective study of Japanese subjects aged 30–74 years was undertaken using data collected from 6,276 participants (2,285 men and 3,991 women) in cardiovascular risk surveys conducted in four communities between 1995 and 1998. We used the Spielberger Anger Expression Scale to measure self-reported levels of anger expression style; anger expressed outwardly is regarded as “anger-out” and anger held in or suppressed is classified as “anger-in.” The incidence of stroke was ascertained by systematic surveillance. The hazard ratios (HRs) of incidence of stroke and its subtypes and 95% confidence intervals (CI) relative to the lowest tertile of anger expression were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazards model. Results: During an average follow up of 9.1-years, 129 incident strokes (50 hemorrhagic, 77 ischemic, and 2 unclassified strokes) occurred. Men with “anger-in” scores in the highest tertile had a 1.7-fold multivariable-adjusted relative risk of stroke as compared with those in the lowest tertile, but it did not reach statistical significance (HR; 1.73, 95% CI; 0.94–3.19, p=0.08). When stratifying for stroke subtypes, the associations between “anger-in” and stroke tended to be stronger for hemorrhagic stroke than ischemic stroke; HRs (95% CI) were 3.82 (1.03–14.1) for hemorrhagic stroke and 1.32 (0.64–2.71) for ischemic stroke. Anger-in score was not associated with incidence of either hemorrhagic or ischemic stroke in women. In men and women, there were no significant associations between “anger-out” and incidence of stroke. As compared with the lowest tertile of “anger-out” scores, the multivariable-adjusted HRs of stroke for the highest tertile of “anger-out” scores were 1.39 (0.74–2.59) for men and 1.48 (0.78–2.78) for women, respectively. Conclusions: Suppressed anger may be associated with increased risk of hemorrhagic stroke among middle-aged Japanese men, but not women.

Self-Reported Snoring Frequency and Incidence of Cardiovascular Disease: The Circulatory Risk in Communities Study (CIRCS)

BackgroundAlthough associations between snoring and cardiovascular disease have been reported in several prospective studies, there is limited evidence from Asian populations. The objective of this study was to determine if there is an association between self-reported snoring frequency and the incidence of cardiovascular disease in Japanese.MethodsThe subjects were 2350 men and 4163 women aged 40 to 69 years who lived in 3 communities in Japan. All subjects were participants in the Circulatory Risk in Communities Study (CIRCS) and were followed for 6 years. Incidence of cardiovascular disease during the follow-up period comprised events of myocardial infarction, angina pectoris, sudden cardiac death and stroke.ResultsDuring the 6-year follow-up period, 97 participants (56 men and 41 women) had cardiovascular events. After adjustment for potential confounding factors, self-reported snoring frequency was associated with an increased risk of cardiovascular events among women but not men. The hazard ratios (95% CI) for cardiovascular events were 0.9 (0.4–2.0) for sometimes snoring and 2.5 (1.0–6.1) for everyday snoring in women and 0.7 (0.3–1.3) and 1.0 (0.5–2.1), respectively, in men. Further adjustment for body mass index attenuated the association in women; the respective hazard ratios for cardiovascular events were 0.9 (0.4–1.9) and 2.1 (0.9–5.4).ConclusionsSelf-reported habitual snoring was associated with increased risk of cardiovascular events among Japanese women. Overweight may partly mediate this association.

Trends in sudden cardiac death and its risk factors in Japan from 1981 to 2005: the Circulatory Risk in Communities Study (CIRCS)

ObjectiveThere is little evidence whether sudden cardiac death (SCD) is increasing in Asia, although the incidence of coronary heart disease among urban middle-aged Japanese men has increased recently. We examined...

P2-178 The associations of dietary folate, vitamin B6 and B12 intakes with risk of sudden cardiac death: the Circulatory Risk in Communities Study (CIRCS)

IntroductionTo examine whether dietary folate, vitamin B6 and B12 intakes are associated with the risk of sudden cardiac death (SCD) among Japanese men and women.MethodWe conducted a nested case-control study....

P2-302 Nocturnal intermittent hypoxia and cardiovascular risk factors in community-dwelling Japanese: the Circulatory Risk in Communities Study (CIRCS)

IntroductionTo investigate whether nocturnal intermittent hypoxia (NIH), a surrogate marker for sleep apnoea, is associated with cardiovascular risk factors, we conducted epidemiological studies.MethodsThe CIRCS is a prospective cohort study across...

SP1-92 Serum α-linolenic acid and disabling dementia among Japanese: the circulatory risk in communities study (CIRCS)

BackgroundInformation on the impact of fatty acid composition on dementia has not yet been elucidated.MethodsWe performed a nested case-control study based on a cohort of approximately 12 000 Japanese people...

P2-177 Accumulation of obesity-related eating behaviours and the incidence of type 2 diabetes among middle-aged Japanese men and women: the Circulatory Risk in Communities Study (CIRCS)

IntroductionTo examine whether the accumulation of obesity-related eating behaviours such as eating quickly, eating until full, eating right before bedtime and breakfast skipping are associated with incidence of type 2...