Japanese Urban Population Research Articles

Association between visceral fat accumulation and decline in the estimated glomerular filtration rate based on cystatin C in the Japanese urban population: the KOBE study.

Although metabolic syndrome, including visceral fat accumulation, causes kidney and cardiovascular diseases, the impact of visceral fat accumulation on mild decreased renal function remains unclear. This study examines the association between visceral fat area (VFA) measured by bioimpedance methods and the estimated glomerular filtration rate based on serum cystatin C (eGFRcys) in the Japanese urban population. This community-based cross-sectional study enrolled 952 individuals (287 men, 665 women) who participated in the second follow-up survey of the Kobe Orthopedic and Biomedical Epidemiological (KOBE) study. We compared the multivariate-adjusted means of eGFRcys among VFA quartile groups by gender using the analysis of covariance. Models were adjusted for age, high blood pressure, hypercholesterolemia, glucose intolerance, smoking, and alcohol use, and further adjusted for body mass index (BMI). The highest VFA quartile group had lower eGFRcys than the lowest VFA quartile group after adjusted for cardiometabolic risk factors, except for BMI (93.1 [95% confidence interval (CI), 90.1-96.2] vs. 82.1 [95% CI, 79.1-85.0] in men and 95.8 [95% CI, 94.1-97.5] vs. 89.4 [95% CI, 87.8-90.9] in women). Moreover, further adjustment for BMI revealed a similar result in men (93.5 [95% CI, 89.8-97.2] vs. 81.6 [95% CI, 77.9-85.3]), while no significant association was found in women. This study suggests a significant association between increased VFA levels and lower eGFRcys levels independent of cardiometabolic risk factors, such as glucose intolerance and hypercholesterolemia in men and women, as well as independent of BMI in men.

Relationship between carotid intima-media thickness and periodontal disease in a Japanese urban population with and without hypertension: The Suita Study.

To investigate the association between periodontal disease and atherosclerosis and to examine whether the association is modified by hypertension status. In this cross-sectional study, 1472 Japanese individuals aged 50-79 years who underwent a medical check-up, dental examination, and carotid ultrasonography were studied. Carotid atherosclerosis was expressed as the maximum and mean carotid intima-media thickness (max-IMT, mean-IMT) and the presence of stenosis (≥75%). Periodontal status was examined by the Community Periodontal Index (CPI, codes 0-4). The participants were divided into three groups according to the periodontal status (CPI0-2, CPI3, CPI4). A positive correlation was found between mean-IMT and periodontal disease after adjustment for cardiovascular risk factors in the entire cohort (mean-IMT in hypertensives: CPI0-2: 0.848 mm, CPI3: 0.857 mm, CPI4: 0.877 mm; normotensives: 0.782, 0.802, 0.826). In the entire cohort, the multivariable-adjusted odds ratio of stenosis based on mean-IMT significantly increased according to periodontal status in normotensives (odds ratio; CPI0-2: 1, CPI3: 1.39, CPI4: 2.53; p-value for trend=.004) but showed only marginal significant increase in hypertensives (1, 1.15, 1.55; p-value for trend=.063). No significant relationships were observed for max-IMT in all analyses. We observed an association between periodontal disease and atherosclerosis in normotensive and hypertensive participants.

Abstract 13701: The Lumen Diameter Enlargement of the Carotid Arteries Increased the Risk of Stroke Incidence in a Japanese Urban Population: The Suita Study

Introduction: We aimed to examine the impact of increased LD of common carotid arteries (CCA), external carotid arteries (ECA), and internal carotid arteries (ICA) on the risk of incident stroke in a general population. Methods: We studied 3,356 Japanese men and women without cardiovascular disease whose CCA, ECA, and ICA were measured by carotid ultrasonography on both sides at baseline (October 2001 to March 2005). We confirmed the near and far walls intima-media interfaces by Doppler and calculated the lumen diameter as the distance between the intima-to-lumen interface of the near-wall to the lumen-to-intima interface of the far wall. The Cox proportional hazard model was used to calculate the multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of stroke incidence according to the CCA, ECA, and ICA LD. Results: During 30,818 person-years of follow-up, we observed 105 incident stroke cases. The higher CCA and ECA LD were associated with increased risks of incident stroke. The associations were attenuated by additional adjustment for blood pressure levels and antihypertensive drugs use, but remained statistically significant. Further adjustment of other traditional cardiovascular risk factors and carotid plaque did not alter the association materially; the multivariable-adjusted HR per standard deviation increase of CCA LD was 1.30 (95% CI, 1.05 to 1.61). Compared with participants in the first quartile (< 4.8 mm) of ECA LD, the multivariable-adjusted HRs of incident stroke were 1.71 (95% CI, 0.86 to 3.38) for those in the second quartile (4.8 - 5.3 mm), 2.18 (95% CI, 1.13 to 4.23) for the third quartile (5.4 - 6.0 mm), and 1.62 (95% CI, 0.79 to 3.29) for the fourth quartile (≥ 6.0 mm) of ECA LD. Such associations were not observed for ICA LD. Conclusions: In addition to the traditional risk factors and carotid plaque, CCA and ECA LD can improve risk reclassification of incident stroke in a general urban population.

Clinical impact of cardiac magnetic resonance in patients with suspected coronary artery disease associated with chronic kidney disease (AQUAMARINE-CKD study): study protocol for a randomized controlled trial

BackgroundAlthough screening for coronary artery disease (CAD) using computed tomography coronary angiography in patients with stable chest pain has been reported to be beneficial, patients with chronic kidney disease (CKD) might have limited benefit due to complications of contrast agent nephropathy and decreased diagnostic accuracy as a result of coronary artery calcifications. Cardiac magnetic resonance (CMR) has emerged as a novel imaging modality for detecting coronary stenosis and high-risk coronary plaques without contrast media that is not affected by coronary artery calcification. However, the clinical use of this technology has not been robustly evaluated.MethodsAQUAMARINE-CKD is an open parallel-group prospective multicenter randomized controlled trial of 524 patients with CKD at high risk for CAD estimated based on risk factor categories for a Japanese urban population (Suita score) recruited from 6 institutions. Participants will be randomized 1:1 to receive a CMR examination that includes non-contrast T1-weighted imaging and coronary magnetic angiography (CMR group) or standard examinations that include stress myocardial scintigraphy (control group). Randomization will be conducted using a web-based system. The primary outcome is a composite of cardiovascular events at 1 year after study examinations: all-cause death, death from CAD, nonfatal myocardial infarction, nonfatal ischemic stroke, and ischemia-driven unplanned coronary intervention (percutaneous coronary intervention or coronary bypass surgery).DiscussionIf the combination of T1-weighted imaging and coronary magnetic angiography contributes to the risk assessment of CAD in patients with CKD, this study will have major clinical implications for the management of patients with CKD at high risk for CAD.Trial registrationJapan Registry of Clinical Trials (jRCT) 1,052,210,075. Registered on September 10, 2021.

Tooth Loss Related with Prevalence of Metabolic Syndrome in a General Urban Japanese Population: The Suita Study

We examined whether the number of teeth could be a surrogate marker for metabolic syndrome (MetS) risk in cross-section. A total of 3771 individuals from the general urban Japanese population (1690 men, 2081 women; mean age 67.1 ± 11.0 years) participated in this study. Participants were diagnosed with MetS with three or more components hypertension, hyperglycemia, lipid metabolism abnormality, and abnormal abdominal girth. Questionnaires were administered to determine the number of teeth, smoking status, drinking status, and past illnesses. To clarify the relationships between the number of teeth and the presence of MetS components, we divided subjects into two groups: those with less than 20 residual teeth and those with 20 or more, then statistical analyses (Mantel-Haenszel tests and logistic regression analysis) were performed. MetS were higher for those with ≤19 teeth than those with ≥20 teeth when examining all participants and women-only groups. Hyperglycemia, low HDL cholesterol, high triglycerides, and diagnosis with MetS were all significantly higher in the ≤19 teeth group for both sexes combined and for women. These results suggest that less than 20 teeth may be a surrogate marker for MetS risk, but further studies on gender differences and pathological background are needed.

The Risk of Fasting Triglycerides and its Related Indices for Ischemic Cardiovascular Diseases in Japanese Community Dwellers: the Suita Study.

Aim: A prospective cohort study in a Japanese urban general population was performed to investigate whether triglyceride (TG) and its related indices were associated with the risk for the incidence of ischemic cardiovascular disease (CVD) after the adjustment for low-density lipoprotein cholesterol (LDL-C) in Asian community dwellers. Methods: A 15.1-year prospective cohort study was performed in 6,684 Japanese community dwellers aged 30–79 years without a history of CVD and whose fasting TG levels were ＜400 mg/dL. After adjusting for covariates, including LDL-C, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of the deciles (D) of TG and those of 1-standard deviation (SD) increment of log-transformed TG (1-SD of TG) according to LDL-C level (≥ 140 and ＜140 mg/dL) for ischemic CVD incidence were estimated. The multivariable-adjusted HRs and 95%CIs of the quintiles (Q) of TG, TG/HDL-C, and the cardiometabolic index (CMI) for ischemic CVD were also estimated. Results: In 101,230 person-years, 464 ischemic CVD cases occurred. For D 10 of TG, the HR (95%CI) was 1.56 (1.05–2.32), and for 1-SD of TG, it was 1.30 (1.00–1.70) in participants with LDL-C ＜140 mg/dL and 1.07 (0.77–1.50) in those with LDL-C ≥ 140 mg/dL. For Q 5 of the CMI, the multivariable-adjusted HR was higher than those of TG and TG/HDL-C. Conclusions: Fasting TG was an independent predictor for ischemic CVD incidence after adjusting for LDL-C in Japanese community dwellers with TG ＜400 mg/dL. Among TG, TG/HDL-C, and the CMI, the CMI could be the most powerful predictor for ischemic CVD.

Association between declines in objective masticatory performance and salivary stress markers: The Suita study.

Dentists often encounter patients suffering from psychological and social stress due to declines in masticatory performance, making this a critical issue to manage. We aimed to clarify the relationships between salivary stress markers as objective indices of chronic stress and objective masticatory performance in a general urban Japanese population. Data from 880 participants (mean age, 65.8years) in the Suita study were used. Salivary interleukin (IL)-6 and cortisol concentrations were measured by enzyme-linked immunosorbent assay. Objective masticatory performance was determined by measuring the increase in surface area test gummy jelly after 30 times chewing. Participants were divided into two groups based on masticatory performance: a decreased group (lowest quartile) and a non-decreased group (second to fourth quartiles). Odds ratios (ORs) of higher salivary levels of stress markers (highest quartile) according to masticatory performance were estimated using logistic regression analysis adjusting for age, sex, periodontal status, salivary flow rate and smoking habit. Salivary IL-6 level was significantly higher in the decreased group than in the non-decreased group. Logistic regression analysis showed the adjusted OR for higher salivary IL-6 was significantly higher in the decreased group than in the non-decreased group (OR=1.92; 95% confidence interval=1.33-2.76; P<.001). No significant associations were found between salivary cortisol and decreased masticatory performance in any analyses. Declines in objective masticatory performance may correlate with higher salivary IL-6 level as an objective index of chronic stress.

Decreased masticatory performance is related to increased intima-media thickness in a general urban Japanese population: The Suita study

PurposeThe association between periodontal disease and carotid atherosclerosis has been widely discussed, but to our knowledge, no population-based studies have been conducted on the association between masticatory ability and carotid atherosclerosis. We aimed to clarify the hypothesis that objectively accessed masticatory performance is related to increased intima-media thickness (IMT) in a general urban population. MethodsWe studied 1,484 Japanese (mean age: 66.9 y) from the Suita study. Masticatory performance was measured using test gummy jelly, and periodontal status was evaluated using the Community Periodontal Index (CPI). Carotid ultrasonography was performed to measure maximum IMT (max-IMT) in the entire area of the carotid arteries. Analysis of covariance was used to compare max-IMT according to quartiles of masticatory performance adjusted by cardiovascular risk factors and periodontal status. ResultsMultivariable-adjusted max-IMT (standard error) was significantly higher in the lowest masticatory performance quartile group (decreased group) (1.58 ± 0.03 and 1.44 ± 0.03 mm) than in the 2nd to 4th quartiles combined (non-decreased groups) in both sexes (1.48 ± 0.02 mm, trend P = 0.038) and in women (1.34 ± 0.02 mm, trend P = 0.013), respectively. In participants without cardiovascular risk factors (n = 250), multivariable-adjusted max-IMT was significantly higher in the decreased (1.54 ± 0.06, 2.08 ± 0.22, and 1.42 ± 0.06 mm) than in the non-decreased groups in both sexes (1.31 ± 0.04 mm, trend P = 0.006), in men (1.41 ± 0.12 mm, trend P = 0.028), and in women (1.28 ± 0.04 mm, trend P = 0.073). ConclusionsThese findings suggest that decreased masticatory performance may be related to carotid IMT progression in the general urban Japanese population.

Abstract P025: Left Atrial Dilatation Predicts The Incidence Of Persistent Atrial Fibrillation In Japanese General Population; The Suita Study

Objective: Atrial fibrillation (AF) is an important risk factor for cardiovascular disease (CVD). Left atrial (LA) dilatation detected by ultrasonic cardiography (UCG) has been reported to be associated with the incidence of AF in Western countries. However, the relationship between LA dilatation and the AF incidence has not been well investigated in Asian countries, with lower incidence of AF and obesity and with higher incidence of hypertension and stroke. To investigate the relationship between LA dilatation and the AF incidence in Japanese general population, we estimated the multivariate-adjusted hazard ratios (HR) of LA dilatation assessed by UCG for the incidence of AF. Methods: Participants were 1,585 individuals without AF (665 men, 920 women) who are the participants of a prospective cohort study for CVD incidence in urban Japanese general population (the Suita study). The mean±SD age of the participants were 67.8±7.0 years. Transthoracic UCG was performed from July in 2007 to June in 2013, and LA dimension was determined in accordance with American Society of Echocardiography recommendations by M-mode echocardiograms. After the UCG, the electrocardiograms (ECG) were repeatedly performed until March in 2016. The physicians coded the ECG using Minnesota Code (MC), and AF code is defined as 8-3-1. The HRs of LA dilatation for the incidence of AF with 95% confidence interval (CI) were estimated by Cox proportional hazard model with the adjustment for the followings at the UCG test; age, sex, systolic blood pressure, body mass index, the presence of heavy drinking (more than 2 drinks/day), non-HDL cholesterol, and the presence of the moderate or severe mitral or aortic valve abnormality detected by UCG. Results: The mean follow-up period from UCG to the last ECG was 4.6±1.8 years, and 19 AF incidences were detected. The multivariate-adjusted HR of the LA dilatation (&gt;40 mm) for the incidence of AF was 8.19 (95% CI: 2.47-27.14). And the multivariate-adjusted HR of 5 mm increment of LA dimension was 2.95 (1.65-5.29), and that of the highest quartile of LA dimension compared to the lowest was 3.37 (0.64-17.78). Among 674 participants with left atrial volume index (LAVI) data (5 AF cases), the multivariate-adjusted HR of LAVI ≥ 32 (ml/m 2 ) for AF incidence was 3.93 (95%CI: 0.34-45.86), and it showed the highest HR among the co-adjusted factors. Conclusion: LA diameter assessed by UCG is a simple and non-invasive clinical data, and could be a useful factor for the prediction of AF incidence among Japanese general population. Although the follow-up period was not enough compared to the previous studies in Western population, the present study might indicate that individuals with LA dilation detected by UCG are the important candidate for careful and continuous check-ups about CVD risk factors, ECG and UCG in Asian population.

Abstract WP197: Increased Carotid Intima-Media Thickness is Associated ith Incident Coronary Heart Disease and Stroke in a Japanese General Population With a 12.6-year Follow-up: The Suita Study

Introduction: Carotid intima-media thickness (IMT) is increasingly used as a subclinical marker of cardiovascular disease. However, few studies have examined the association between IMT and incident coronary heart disease (CHD) and stroke in non-Westerners. We assessed the hypothesis that carotid atherosclerosis is a predictor of CHD and stroke events in a general urban Japanese population. Methods: We studied 4,751 Japanese (2181 men and 2570 women, mean age 59.8 years, without stroke or CHD at the baseline) who completed a baseline survey and carotid atherosclerosis in the Suita Study, and were then followed for an average of 12.6 years. Carotid atherosclerosis was evaluated by high-resolution ultrasonography with atherosclerotic indexes of IMT in the common carotid artery (CCA) and the carotid artery bulb. Mean IMT was defined as the mean of the IMT of the proximal and distal walls for both sides of the CCA at a point 10 mm proximal to the beginning of the dilation of each carotid artery bulb. Max-CCA and Max-Bulb were defined as the maximum IMT in the CCA and bulb areas, respectively. We used adjusted Cox proportional-hazards models to compare the risk of CHD and stroke by use of mean and maximum carotid IMT in the CCA and bulb areas. Results: During the follow-up, we documented 145 cerebral infarctions, 58 hemorrhagic strokes, 20 unclassified strokes, and 159 CHD. The adjusted hazard ratios (HRs; 95% confidence intervals [CI], P for trend [P trend]) in the fourth quartile (≥ 0.95 mm) of the mean IMT for strokes, cerebral infarction, and CHD were 3.13 (1.48-6.63, P trend = 0.002), 3.34 (1.33-8.37, P trend = 0.002), and 1.93 (0.96-3.88, P trend &lt;0.0001), respectively, compared with the first quartile (&lt;0.775 mm). The adjusted HRs (95% CI) in the fourth quartiles of Max-CCA (≥1.10 mm) and Max-BIF (≥1.55 mm) were 2.48 (1.10-5.62, P trend = 0.07) and 3.28 (1.40-7.69, P trend &lt;0.0001) in stroke, 1.87 (0.75-4.659, P trend = 0.07) and 2.83 (1.05-7.63, P trend = 0.005) in cerebral infarction, and 3.07 (1.18-8.04, P trend &lt;0.0001) and 6.01 (2.02-17.9, P trend &lt;0.0001) in CHD, respectively, compared with the first quartiles (&lt;0.9 mm). Conclusions: Carotid IMT, especially Max-BIF was a strong predictor of stroke, cerebral infarction, and CHD in a Japanese urban general population.

Relationship between metabolic syndrome and objective masticatory performance in a Japanese general population: The Suita study

ObjectivesAn association between metabolic syndrome (MetS) and periodontal status has recently been focused on. However, no study has investigated the relationship between the prevalence of MetS and the decline of masticatory performance. We aimed to clarify the relationship between MetS and objective masticatory performance using the standardized test food in a general urban Japanese population. MethodsWe studied 1780 Japanese men and women (mean age, 66.5 years) using the Suita study. MetS was defined using the uniform definition proposed in the 2009 Joint Interim Statement. Masticatory performance was evaluated by a chewing test using gummy jelly. Prevalence of MetS among quartiles of masticatory performance was compared using multiple logistic regression analysis adjusting for sex, age, drinking and smoking status, and periodontal status evaluated by the Community Periodontal Index. ResultsCompared to the highest quartile of masticatory performance, the 2nd quartile showed a 1.46-fold increase in the prevalence of MetS (trend P=0.159). In addition, Analysis by age showed 1.67-, 1.90- and 1.74-fold increases in the prevalence of MetS in the 3rd, 2nd and 1st quartiles among individuals in their 70s, respectively (trend P=0.094). However, individuals in their 50s and 60s showed no significant relationship between masticatory performance and MetS. ConclusionsThese findings suggested that masticatory performance are inversely associated with the prevalence of MetS independent of periodontal disease, especially in the elderly. Clinical significanceDeclines in objective masticatory performance might be associated with the prevalence of MetS, independent of periodontitis. Given our results, treatments aimed at maintaining and recovering masticatory performance may represent important dental care to mitigate the risk of MetS.

Predicting Coronary Heart Disease Using Risk Factor Categories for a Japanese Urban Population, and Comparison with the Framingham Risk Score: The Suita Study.

Predicting Coronary Heart Disease Using Risk Factor Categories for a Japanese Urban Population, and Comparison with the Framingham Risk Score: The Suita Study.

Does the utilization of dental services associate with masticatory performance in a Japanese urban population?: the Suita study.

There are numerous reports on the relationship between regular utilization of dental care services and oral health, but most are based on questionnaires and subjective evaluation. Few have objectively evaluated masticatory performance and its relationship to utilization of dental care services. The purpose of this study was to identify the effect of regular utilization of dental services on masticatory performance. The subjects consisted of 1804 general residents of Suita City, Osaka Prefecture (760 men and 1044 women, mean age 66.5 ± 7.9 years). Regular utilization of dental services and oral hygiene habits (frequency of toothbrushing and use of interdental aids) was surveyed, and periodontal status, occlusal support, and masticatory performance were measured. Masticatory performance was evaluated by a chewing test using gummy jelly. The correlation between age, sex, regular dental utilization, oral hygiene habits, periodontal status or occlusal support, and masticatory performance was analyzed using Spearman's correlation test and t‐test. In addition, multiple linear regression analysis was carried out to investigate the relationship of regular dental utilization with masticatory performance after controlling for other factors. Masticatory performance was significantly correlated to age when using Spearman's correlation test, and to regular dental utilization, periodontal status, or occlusal support with t‐test. Multiple linear regression analysis showed that regular utilization of dental services was significantly related to masticatory performance even after adjusting for age, sex, oral hygiene habits, periodontal status, and occlusal support (standardized partial regression coefficient β = 0.055). These findings suggested that the regular utilization of dental care services is an important factor influencing masticatory performance in a Japanese urban population.

PP.16.12

Objective: The transitional zone (clockwise/ counterclockwise rotation) in an electrocardiogram (ECG) during sinus rhythm is a simple, distinct, and common finding. No prospective study has examined the association between transitional zones and incident cardiovascular diseases (CVDs) in general population. We assessed the hypothesis that, compared to normal rotation, counterclockwise and clockwise rotation is associated with poor and good risk of CVDs, respectively. Design and method: We evaluated the 5,331 study participants (30–83 years; 47% men) without prior CVDs in a prospective cohort of the Japanese urban population. In a resting 12- lead ECG, the transitional zone was classified as counterclockwise, normal, or clockwise rotation. Cox regression analyses were performed to estimate the hazard ratios (HRs) of CVDs after adjusting for other cardiovascular risk factors. Results: During 13.1 years of follow-up, 410 CVDs and 175 coronary heart diseases were observed. Among men, the prevalence of hypertension in the counterclockwise, normal, or clockwise rotation group was 28, 34, and 40%, respectively (p < 0.01). Among women, the prevalence of hypertension in the counterclockwise, normal, or clockwise rotation group was 23, 29, and 35%, respectively (p < 0.01). Compared with normal rotation, counterclockwise rotation was significantly associated with decreased risk of CVDs incidences in women (HR (95% confidence interval [CI]): 0.64 (0.42–0.97)). In the stratified analyses, counterclockwise rotation was significantly related with decreased risks of CVDs incidences in women with lower cardiovascular risks, the relatively younger participants, never cigarette smokers, never alcohol drinkers and those without hypertension, hypercholesterolemia or abdominal obesity. Meanwhile, in the stratified analyses of men, clockwise rotation was significantly related with elevated risks of CVDs incidences in the never-smokers, but related with decreased risk of CVDs in the ever-smokers (HRs (95% CI): 2.64 (1.16–6.02) and 0.65 (0.43–0.98), respectively, Interaction p = 0.01). Conclusions: Counterclockwise rotation in 12-lead ECG was associated with decreased risks of CVDs in the urban Japanese women. Clockwise rotation was significantly related with elevated risks of CVDs incidences in the never-smoking men. This is the first prospective cohort study that the transitional zones in ECG could be useful to estimate elevated or decreased risks of CVDs incidences.

Abstract 467: A Combination of Metabolic Syndrome Components Increased the Risk of Incident Atrial Fibrillation in a General Urban Cohort: the Suita Study

Background: Atrial fibrillation (AF), the most common chronic arrhythmia, is linked to increased risks of mortality and cardiovascular disease. Few prospective studies have examined the combined effect of metabolic syndrome (Mets) components on the incidence of AF in a general population. We investigated whether combinational Mets components increase the risk of incident AF in an urban Japanese population. Methods: The 6,659 Suita Study participants (30-84 yrs old) were initially free of AF and prospectively followed up for incident AF. Standard 12-lead ECGs were obtained from all subjects in the supine position. The participants were diagnosed with AF if AF or atrial flutter was present on ECGs obtained during a biannual routine health examination or if AF was indicated as a present illness by questionnaire, medical records, or the registration of one or more cardiovascular disease events during follow-up. The Mets components were defined as follows: higher blood pressure (HBP, systolic/diastolic BP ≥130/85 mmHg or use of antihypertensive medication), hyperglycemia (fasting plasma glucose &gt;100 mg/dL or use of diabetes medication), hypertriglyceridemia (HTG, serum triglyceride &gt;150 mg/dL or use of medication for HTG), lowered HDL cholesterolemia (HDL &lt;40 mg/dL in men and &lt;50 mg/dL in women), and central obesity (waist circumference &gt;85 cm in men and &gt;80 cm in women). The definition of Mets was used for the current international recommendations, which constitutes the presence of any three or more of five components. Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were analyzed after adjusting for age, gender, smoking, drinking, chronic kidney disease, stroke, and heart disease at baseline. Results: During the 13 years of follow-up, 242 incident AF events occurred. The adjusted HRs (95% CIs) of incident AF for central obesity, HBP, and Mets were 1.39 (1.06-1.82), 1.41 (1.08-1.85), and 1.34 (1.03-1.75), respectively. Compared with the absence of the components, the adjusted HR (95% CIs) of incident AF for subjects with any three components was 1.72 (1.11-2.67). Conclusion: Mets, central obesity, and HBP are risk factors for incident AF. Appropriate BP and body weight are important for preventing AF in the general population in Japan.

Sleep-disordered breathing is associated with elevated human atrial natriuretic peptide levels in a Japanese urban population: The Suita study

Sleep-disordered breathing is associated with elevated human atrial natriuretic peptide levels in a Japanese urban population: The Suita study

Predicting Coronary Heart Disease Using Risk Factor Categories for a Japanese Urban Population, and Comparison with the Framingham Risk Score: The Suita Study

The Framingham risk score (FRS) is one of the standard tools used to predict the incidence of coronary heart disease (CHD). No previous study has investigated its efficacy for a Japanese population cohort. The purpose of this study was to develop new coronary prediction algorithms for the Japanese population in the manner of the FRS, and to compare them with the original FRS. Our coronary prediction algorithms for Japanese were based on a large population-based cohort study (Suita study). The study population comprised 5,521 healthy Japanese. They were followed-up for 11.8 years on average, and 213 cases of CHD were observed. Multiple Cox proportional hazard model by stepwise selection was used to construct the prediction model. Our coronary prediction algorithms for Japanese patients were based on a large populationbased cohort study (the Suita study). A multiple Cox proportional hazard model by stepwise selection was used to construct the prediction model. The C-statistics showed that the new model had better accuracy than the original and recalibrated Framingham scores. The net reclassification improvement (NRI) by the Suita score with the inclusion of CKD was 41.2% (P＜0.001) compared with the original FRS. The recalibration of the FRS slightly improved the efficiency of the prediction, but it was still worse than the Suita score with the CKD model. The calibration analysis suggested that the original FRS and the recalibrated FRS overestimated the risk of CHD in the Japanese population. The Suita score with CKD more accurately predicted the risk of CHD. The FRS and recalibrated FRS overestimated the 10-year risk of CHD for the Japanese population. A predictive score including CKD as a coronary risk factor for the Japanese population was more accurate for predicting CHD than the original Framingham risk scores in terms of the C-statics and NRI.

Additive Interaction of Oral Health Disorders on Risk of Hypertension in a Japanese Urban Population: The Suita Study

This study assessed the relationship between different oral health markers-periodontitis, gingival bleeding, tooth number, and occlusal status-and hypertension in a Japanese urban population. A total of 1,643 participants with no prior cardiovascular disease (mean age = 66.6 years; 43.4% women) underwent comprehensive health checkups, including a lifestyle questionnaire and dental examination in the Suita Study. In the multivariable-adjusted logistic model, none of the individual oral health markers, namely severe periodontitis, gingival bleeding, lowest quartile of tooth number, and malocclusion, were significantly associated with increased odds of hypertension. The additive effects of oral health markers on hypertension were examined and showed that, compared with subjects with no component of the oral health markers, the multivariale-adjusted odds ratio of hypertension in those with ≥3 components was 1.82 (95% confidence interval (CI) = 1.23-2.72; P = 0.003). In the subpopulation without antihypertensive medication (n = 1,148; 59.8% women), a significant graded relationship between multivariable-adjusted systolic blood pressure and the number of components was found (P trend = 0.03), and, compared with subjects with no component of the oral health markers, having ≥3 components was related to a higher systolic blood pressure (β = 5.41; 95% CI = 1.16-9.66; P = 0.01). There is an additive relationship between oral health disorders and risk of hypertension. Our results suggest that the existence of moderate or severe oral health disorders-that is, several concomitant oral health disorders-is associated with risk of hypertension.

Spousal Choice by Height in an Urban Middle-Class Japanese Population

Spousal Choice by Height in an Urban Middle-Class Japanese Population Keiko Uchida, Nobutake Matsuo, Naoki Hori, Tomonobu Hasegawa, and Takao Takahashi Dear Editor, In Western populations, the similarity between spouses is well documented for a variety of anthropometric variables such as height and body mass index. However, relatively little information is available on assortative mating in height in other ethnic populations. A study on a small, exclusively agricultural community on Kyushu island (Furusho 1961) was quoted in English literature as representative of the Japanese population. The study showed that spousal correlation coefficient was +0.072 ± 0.057 in 431 couples, and based on this finding, it was concluded that Japanese do not practice homogamy for body size (Spuhler 1982). Nevertheless, the current agricultural population comprises <3% of the entire population of Japan, and the above study does not represent the Japanese population at large. Further, that study was conducted in the postwar period of 1959, when the farming community suffered from a shortage of male due to compulsory draft and war deaths in preceding decades, making assortative mating for anthropometric variables more or less unrealistic in this population. Another study addressed spousal correlation for height in Japanese urban populatons in the 1930s (Yoshida 1941). The study subjects were 2,410 couples who were parents of school children and residents in Tokyo and other urban communities. The spousal correlation for height was 0.220 ± 0.019, indicating the presence of positive assortative mating in urban Japanese populations. We present additional data to indicate a stable, weak spouse correlation for height for urban Japanese population. The study subjects were 421 Japanese couples who gave birth to their children at a company-owned general hospital in Tokyo in 1984–1993. Their heights were measured one month after delivery by the same stadiometer in the clinic by trained pediatric nurses. Of the subjects, either male spouse or female spouse was an employee of the company that runs the hospital. Demographic characteristics of the study subjects are given in Table 1. The mean (SD) height was 170.5 (5.8) cm for male spouses and 157.3 (5.0) cm for female spouses, each being comparable to the mean height of the 2009 national survey for 17.5-year-olds: 170.8 cm for boys and 157.9 cm for girls. We also compared these mean heights with those of the 1976 national survey for 17.5-year-olds for boys and the 1978 national survey for 17.5-year-olds for girls (168.8 cm for males, 156.6 cm for females). The results indicate that the mean height of our [End Page 619] study subjects was slightly taller than that of the 1976–1978 national survey data for 17.5-year-olds of both sexes. Click for larger view View full resolution Table 1. Demographic Characteristics of the Study Subjects Click for larger view View full resolution Table 2. Spousal Correlations in Height Table 2 shows the correlation coefficient between spousal heights for the 421 couples, along with those of previous studies on Japanese couples. The correlations in the two studies on urban populations are in agreement with each other, but there is no spousal correlation for height in the 431 couples from the agricultural population. Table 3 shows different levels of sexual dimorphism in stature in the 421 couples studied. The couples were divided into six levels by magnitude of male-female height ratio based on the scheme of Pawlowski (2003). There were 394 male-taller couples (93.6%) and 3 male-shorter couples (0.7%). The results of the present study provide additional evidence for stable, positive assortative mating for height among urban Japanese population, as measured in the 1930s and in 1984–1993. We also identified that a male-taller norm exists in contemporary urban Japanese population. Collectively, both studies do not support the argument that Japanese do not practice homogamy for body size (Spuhler 1982). A Swedish population-based growth study (n = 2,402) and the British National Child Development Study (n = 6,192) gave nearly identical results in the spousal correlation coefficient, 0.27 for Swedish population and 0.28 for British population, suggesting a common phenotypic...

Abstract WP182: Relationship Between Carotid Intima-Media Thickness and Periodontal Disease in an Urban Japanese Population: The Suita Study

Background and Purpose: The association between periodontal disease and carotid intima-medial thickness (IMT) has been controversial. There are few population-based studies on the association. We assessed the hypothesis that periodontal disease was a risk factor for carotid atherosclerosis in a general urban Japanese population. Research design and methods: We studied 1,484 Japanese individuals (mean age 66.9 years) who underwent medical check-up, dental examinations, and carotid ultrasonography with atherosclerotic indexes of IMT in the common carotid artery (CCA), carotid artery bulb, and internal and external carotid arteries. Mean IMT was defined as the mean of the proximal and distal walls IMT for both sides of the CCA at a point 10 mm proximal to the beginning of each bulb. Subjects were divided into two groups: plaque (-) (maximum IMT less than 1.1 mm, n=235) and plaque (+) groups (maximum IMT equal or more than 1.1 mm, n=1249). Periodontal status was examined by Community Periodontal Index (CPI, code 0-4) by which subjects with CPI code equal or more than 3 (periodontal pocket [PP] group, n=758) and those with CPI code 4 (severe periodontitis [SP] group, n=244). We examined the relationship between plaque (+/-) and periodontal status by using age- and sex-adjusted chi-square test. Logistic regression model was used to analysis of mean and maximum IMT according to the periodontal status adjusted by cardiovascular risk factors. Results: Plaque (+) group tended to have periodontal pocket in both men and women (odd ratio [OR] =1.84, P&lt;0.000). Women with plaque (+) tended to have periodontal pocket (OR=1.19, P=0.001) and severe periodontitis (OR=3.14, P=0.002). Mean IMT was significantly higher in both PP and SP groups (adjusted mean IMT= 0.82 mm (CPI code 0-2) and 0.847 mm (PP group), P=0.001; adjusted mean IMT=0.815 mm (CPI code 0-3) and 0.834 mm (SP group), P=0.002). Conclusions: In our population based study, periodontitis may be a risk factor for carotid atherosclerosis, especially in women.