Physical Checkup Program Research Articles

Significance of blood pressure variability in normotensive individuals as a risk factor of developing hypertension

Purpose Visit-to-visit blood pressure variability is a strong predictor of the incidence of cardiovascular events and target organ damage due to hypertension. The present study investigated whether year-to-year blood pressure variability predicts the risk of hypertension in the Japanese general population. Materials and methods This study analysed 2806 normotensive individuals who participated in our physical check-up program for five years in a row from 2008 to 2013. The average, standard deviation, coefficient of variation, average real variability, and highest value of systolic blood pressure in the five consecutive visits were determined and used as baseline data. The participants were followed up for the next 6 years with the development of ‘high blood pressure’, an average blood pressure level of ≥140/90 mmHg or the use of antihypertensive medications, as the endpoint. Result During follow-up, ‘high blood pressure’ developed in 389 participants (13.9%, 29.5 per 1 000 person-years). The incidence increased across the quartiles of standard deviation and average real variability, while the average and highest systolic blood pressure had the most prominent impact on the development of ‘high blood pressure’. Multivariate logistic regression analysis adjusted for possible risk factors indicated that the average, standard deviation, average real variability, and highest blood pressure, but not the coefficient of variation of systolic blood pressure, were significant predictors of ‘high blood pressure’. Conclusion Increased year-to-year blood pressure variability predicts the risk of hypertension in the general normotensive population. The highest blood pressure in the preceding years may also be a strong predictor of the risk of hypertension.

PS-BPP02-2: BLOOD PRESSURE VARIABILITY PREDICTS THE DEVELOPMENT OF HYPERTENSION IN NORMOTENSIVE INDIVIDUALS

Objective: Hypertension is one of the important risk factors for atherosclerosis leading to cardiovascular diseases. Although several factors have been reported as predictors of new onset of hypertension, the association of blood pressure (BP) variability in normotensive subjects with future development of hypertension is not intensively discussed. We tested the hypothesis that the yearly variability of BP in normotensive subjects predicts new onset of hypertension. Design and Methods: Subjects who participated in our annual physical check-up program for 5 years in a row during 2008 and 2013 were screened (screening period) and those under antihypertensive medication or with the average BP for the 5 visits ≧ 140/90 mmHg were excluded. The rest of 2006 participants (male = 1287) were eligible in the present study. Standard deviation (SD) and coefficient of variation (CV) of their systolic BP (SBP) during the 5 consecutive visits were calculated (screening period) and, then, they were followed up for the next 5 years (follow-up period). The onset of hypertension was defined as average BP during the follow-up period ≧ 140/90 mmHg or the use of antihypertensive medications. Results: The average, SD, and CV of SBP were 118.7 ± 10.0 mmHg, 7.44 ± 2.98 mmHg, and 6.30 ± 2.54%, respectively. During the follow-up, hypertension developed in 259 subjects, with the incidence being more frequent in male (n = 180, 14.0%) than female subjects (n = 79, 11.0%). In retrospective analysis, the average (128.7 ± 7.7 vs. 117.2 ± 9.5 mmHg, p < 0.001) and SD (8.05 ± 3.48 vs. 7.34 ± 2.89 mmHg, p < 0.001) were higher in subjects with than without future hypertension, whereas CV was not different in the both groups (6.28 ± 2.73 vs. 6.30 ± 2.51%). Non-adjusted odds ratio (OR) (95% confidence interval [CI]) of average, SD and CV for the incident hypertension were 1.169 (1.146–1.193), 1.078 (1.034–1.124) and 0.997 (0.947–1.050), respectively. Multivariate logistic regression analysis adjusted for age, gender, family history of hypertension, frequent alcohol consumption (six or seven times per week), current smoking, body mass index, heart rate, serum creatinine, fasting plasma glucose, LDL-cholesterol, and triglyceride at baseline demonstrated that average (OR [95%CI] = 1.193 [1.138–1.187]) and SD (1.058 [1.014–1.105]), but not CV (0.992 [0.941–1.046]), were associated with new onset hypertension. Similar results were obtained using diastolic BP (data not shown). Conclusions: In normotensive subjects, an increase in year-to-year variability as well as average of SBP may be a predictor of the new onset of hypertension. Careful interpretation of year-to-year BP variability is necessary for evaluation of future cardiovascular risk in normotensive individuals.

Establishing the blood reference interval of pancreatic elastase-1: A prospective study.

Pancreatic elastase-1 (PE-1) has been investigated in pancreatic disorders. However, the reference interval (RI) of PE-1 in blood remains unconfirmed. We aimed to establish the blood RI of PE-1 in an adult population. In this prospective cross-sectional study, we enrolled 400 adults who had received the whole-body physical check-up program between May 1, 2019 and November 20, 2019. The serum and plasma PE-1 levels were measured by latex turbidimetric immunoassay in different storage conditions (fresh, refrigerated, and frozen). The 95% and 99% RI of PE-1 were calculated according to the Clinical & Laboratory Standards Institute guidelines. The correlations between PE-1 and other parameters were analyzed using multivariable regression models. Ultimately, 38 patients with acute pancreatitis were prospectively recruited as the validation cohort. The PE-1 levels in fresh serum were highly correlated with those in refrigerated (R2 =0.998) or frozen (R2 =0.942) samples; however, plasma should not be suggested in frozen conditions (plasma vs serum: R2 =0.185). In the RI study population (202 male & 198 female participants), the median age was 52.6 (25-75% interquartile range: 43.1-61.0). The 95% and 99% RIs of PE-1 were 30.0-221.0 and 22.0-359.0ng/dL, respectively. Triglycerides (β=0.106, P=0.033), lipase (β=0.154, P=0.007), and CA19-9 (β=0.130, P=0.008) were independent factors associated with PE-1. In the pancreatitis validation cohort, with a cut-off value of 359.0ng/dL, the sensitivity and specificity were 100% and 99.8%, respectively. The RI of PE-1 established in this study can be used for further applications. Serum is the suggested form for frozen sample storage.

Study on the operation process and construction standard of an esophageal cancer screening cohort study

One of the most cost-effective measures in cancer prevention on cancer is to advocate to be aware of the disease, consciously changing negative behaviors, and taking the initiative to participate in regular physical checkup programs. Esophageal cancer is one of the malignant tumors accompanied by a heavy disease burden in China. Routine screening, early diagnosis, and treatment are the critical points of preventing and treating the disease. Cohort studies help understand the natural history and risk factors of esophageal cancer and identify high-risk groups of the disease. This paper intends to discuss the construction specifications of the multi-dimensional dynamic follow-up shared cohort for esophageal cancer by studying the risk factors, monitoring, and collecting biological sample information, providing references for developing a standardized and unified screening cohort research procedure, and necessary standards on esophageal cancer in the future.

Current status and recent changes in blood pressure and dietary salt consumption in Japanese individuals

ABSTRACT Purpose: Treatment of hypertension has recently shown remarkable advances. It is quite important to survey the current general status of blood pressure (BP) and recent changes to verify whether people are benefitting from these advances. The present study aimed to investigate the current status of, and recent changes in, BP, the prevalence and treatment rate of hypertension, the achievement rate of target BP, and salt intake in Japanese individuals. Methods: Recent changes in salt intake as well as BP, the prevalence and treatment rate of hypertension, and the rate of achievement of target BP were investigated in participants in our yearly physical checkup program from 2009 to 2018 (n = 79,789). Individual salt intake was assessed by estimating 24-hour urinary sodium excretion using a spot urine sample. Results: The prevalence of hypertension did not change, but the treatment rate of hypertension (from 64% to 75%) and the achievement rate of the target BP improved during the period (from 35% to 57%). BP decreased, prominently in hypertensive participants under antihypertensive treatment (from 133 ± 14/84 ± 9 to 128 ± 13/76 ± 10 mmHg). Salt intake did not decline noticeably during the 10 years of observation. Conclusions: The prevalence of hypertension did not change, but the treatment rate of hypertension and the achievement rate of the target BP improved during a recent 10-year period. These findings suggest that improved pharmacological management of hypertension resulted in a gradual reduction in BP levels, but lifestyle modification has not yet really taken root in the Japanese general population.

Effect of advancing age on dietary salt intakes: a 10-year follow-up study

Abstract Background/Introduction The National Nutrition Survey in Japan indicated that dietary salt intake of the Japanese is gradually decreasing for the last several decades, while salt intakes are higher in elderly than young people. There is no survey on the alteration of salt intakes with advancing age in individuals. Purpose The present study investigated effects of aging on salt intakes in individuals. Methods A total of 2600 subjects (men; 1787, age; 30 to 79 years-old at 2008) who participated in our physical check-up program both in 2008 and 2018 were enrolled. Individual dietary salt intakes in 2008 and 2018, which were estimated using a spot urine by a previously reported method, were compared. Results The mean age and salt intakes at 2008 were 53.9±10.0 years and 12.2±3.2 g/day in men and 54.4±9.2 years and 8.3±2.1 g/day in women, respectively. Salt intake increased to 13.2±3.3 g/day in men and 8.8±2.2 g/day in women during the 10 years. Salt intakes were higher in hypertensive than normotensive subjects both at 2008 and 2018, but changes of blood pressure category were not associated with those of salt intakes during the 10 years (table). Changes in salt intakes in each decade are shown in Figure. Salt intakes in each decade increased with advancing age both in men and women until their 70s. Salt intakes in people in their 60s and 70s at 2018 were higher than those at 2008. Similar results were obtained in subjects without any anti-hypertensive medications (n=1667) (data not shown). Conclusions The observational follow-up study revealed that salt intakes in each individual increased after the interval of 10 years in both men and women. The results suggest that the sense of taste changes with advancing age in young adults as well as elderly persons, which may be related with alterations of lifestyle. Age difference in changes of salt intake Funding Acknowledgement Type of funding source: None

Effect of occupational factors on pre-diabetes mellitus among iron and steel workers

Objective: To investigate the prevalence of pre-diabetes mellitus (PDM) and the impact of occupation-related factors on PDM, among workers from a steel company in Tangshan city, Hebei province. Methods: Clustering sampling method was used to select a steel company and to carry out occupational health-related physical checkup programs for eligible workers who had working in this company for longer than one year. The study began in February and ended up in June, 2017. Workers who were with FPG level as ≤6.9 mmol/L, and free from diabetes, were selected as the subjects for this study. Questionnaires were used and physical examinations and FPG testing conducted. Results: The total number of subjects in this study was 4 173, of which 2 648 appeared as pre-diabetic, with the prevalence rate as 63.4%. Increase of the PDM prevalence was in parallel with the length of service, among the workers. The risk for the pre-diabetes in those who worked more than 8 hours per day was 1.696 times higher than those who worked less than or equal to 8 h/d (95%CI:1.517-1.937). Compared with those workers without exposures to heat, noise or carbon monoxides, the proportion of pre-diabetes appeared higher in workers exposed to heat, noise or CO with OR=1.782 (95%CI: 1.205-2.636), 1.815 (95%CI: 1.209-2.794) and 1.653 (95%CI: 1.158-2.361), respectively. Risks for those who were exposed to heat or noise were higher than those who were free from exposure to any occupational hazards (OR=2.098, 95%CI: 1.296-3.397). Prevalence rates of pre-diabetes in those who were exposed to heat, noise or CO, were higher than that those who were not. Conclusion: Working hours and exposures to heat, noise or CO appeared as influential factors on PDM.

1415Dose antihypertensive medication improve accelerated age-dependent decline of GFR in hypertension?

Abstract Background/Introduction An impairment of kidney function is a risk not only for end stage renal disease but also for cardiovascular events. Hypertension is known to accelerate an age-dependent decline in glomerular filtration rate (GFR). Purpose Effects of antihypertensive medications on yearly changes of estimate GFR (eGFR) in hypertensive patients were investigated. Methods Consecutive 5110 subjects (male=3196, 52.3±11.3 year-old) who participated in our physical check-up program during 2010 and 2012 were enrolled and followed up for 5 years. The average and the yearly change of eGFR during the 5 years were calculated in each individual and the both values were compared in hypertensive and normotensive subjects. Effect of antihypertensive medication on eGFR was also investigated. The modified Modification of Diet in Renal Disease study formula for the Japanese population was used for calculating eGFR. Results In hypertensive subjects (n=1408), the baseline and the average of eGFR were smaller (74.8±14.6 vs. 80.4±13.6, p<0.001 and 72.1±13.2 vs. 77.9±11.9 mL/min per 1.73 m2, p<0.001, respectively) and the yearly decline of eGFR was greater (0.96±1.41 vs. 0.84±1.19 mL/min per 1.73 m2 per year, p<0.01) than in normotensive subjects (n=3702). The baseline and the average of eGFR were smaller in hypertensive patients with (n=1234) than without (n=174) antihypertensive medication (74.3±14.6 vs. 78.3±13.8, p<0.001 and 71.7±13.2 vs. 74.9±12.7 mL/min per 1.73 m2, p<0.01, respectively). Although the yearly decline of eGFR in hypertensive patients with medication tended to be smaller than the decline in those without medication (0.94±1.41 vs. 1.09±1.42 mL/min per 1.73 m2 per year), this did not reach a statistical significance (p=0.213). Neither the number, classes of antihypertensive medications nor systolic blood pressure during the follow-up period did affect the average or yearly decline of eGFR in hypertensive patients. Conclusions As compared to normotensive subjects, eGFR was reduced and a yearly decrease in eGFR during the 5 years was accelerated in hypertensive patients. Although antihypertensive medication may reduce an accelerated age-dependent decline of kidney function in hypertension, observational period in this study was too short to clarify such beneficial effects of antihypertensive medications.

Evaluation of peer support education mode for type 2 diabetes control in rural residents

Objective: To evaluate the intervention effects of peer support education mode for type 2 diabetes control in rural residents. Methods: A random cluster sampling method has been used, including 300 rural residents aged above 18 years old from three villages (184 in control group, 116 in intervention group), in order to proceed the physical check-up and health education programs. Unchanged rate, transfer rate of patients, rate of impaired glucose tolerance, turn normal rate and other biochemical indicators of patients and people with impaired glucose tolerance from control group and intervention group were analyzed, to evaluate the intervention effects of peer support education mode. Results: The glycemic control rate of intervention group for patients and people with impaired glucose tolerance (72.2% and 71.4%) were higher than control group (43.6% and 26.7%), but the unchanged rate of intervention group (13.9% and 0.0%) were lower than control group (42.3% and 73.3%). Patients with diabetes or glucose intolerance in the education group improved significantly in waist-to-hip ratio, uric acid, total cholesterol and HDL-C. Glycemic hemoglobin level also improved significantly in diabetes patients of the education group. Conclusion: Peer support for education intervention seemed beneficial for diabetic control. The combination of education and effect evaluation was important in the evaluation of diabetes prevention and control. Peer support education also benefited the blood glucose control in general population.

A14935 Airflow limitation predicts the development of hypertension in normotensive smokers

Objectives: Although airflow limitation is reported to be associated with cardiovascular disease, the association with hypertension has not been intensively discussed in normotensive individuals. We studied whether airflow limitation predicts new onset of hypertension in the general population. Methods: Normotensive 5279 participants (male = 3273, 53.2 year-old) in our physical checkup program were enrolled and followed up (median 2177 day) with the endpoint being the development of hypertension. Airflow limitation was evaluated using a ratio of forced expiratory volume in 1 second to a forced vital capacity (FEV1%). Results: At baseline, their FEV1% was 81.5 ± 6.8 %. During the follow-up, hypertension developed in 1531 subjects (57.6 per 1000 person-year). FEV1% at baseline was lower in subjects with than without future hypertension (80.7 ± 6.9 vs. 81.9 ± 6.7 %, p < 0.001) in retrospective analysis. Although non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of FEV1% for the incident hypertension was 0.975 (0.968–0.982), there was no relationship between FEV1% and new onset hypertension in multivariate Cox-hazard analysis. However, when subjects were divided into 3 groups according to smoking status; never smokers (n = 2921), ex-smokers (n = 987) and active smokers (n = 1371), FEV1% was a significant predictor of future hypertension in active smokers by multivariate analysis (HR = 0.983, 95%CI = 0.969–0.997). Conclusion: Airflow limitation is associated with the development of hypertension in the normotensive general population with habitual smoking. Smoking secession is strongly recommended to prevent pulmonary dysfunction and new onset of hypertension.

Risk and related factors on metabolic syndrome among people who had received screening on physical check-up programs, in China

Objective: To explore the risk of developing metabolic syndrome (MS) by using the data from cohorts involving people having received screening programs for physical check-up, in three areas of China (Beijing, Hongkong and Taiwan). Methods: A total number of 6 828 nonmetabolic syndromic adults, who received physical examination for the first time and with records kept for longer than 5 years (between 2004 and 2010) at the MJ centers, were recruited. Criteria developed by the Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Chinese Adults in 2007 (JCDCG-2007) was used for defining the metabolic syndrome. Cox proportional hazards regression model was used to examine the difference of the risk of developing MS among the three cohorts that received the health screening programs. Results: The standardized incidence densities of MS were 3.14 per 100 person-years, 2.19 per 100 person-years and 2.03 per 100 person-years in the cohorts of Beijing, Hongkong and Taiwan, respectively. After adjusting for gender, age, cigarette smoking, dietary patterns at the baseline, the HRs for people in Beijing and Hongkong were 1.60 (95%CI: 1.34-1.91) and 1.08 (95%CI: 0.83-1.41) respectively, in developing MS, when compared with people from Taiwan. Factors as being male, elderly, cigarette smoking, meat/food intake dietary pattern and MS components at the baseline all showed significantly positive effects on the risk of developing MS. Conclusions: There were significant differences regarding the risk of developing MS among health screening people from the Beijing, Hongkong and Taiwan. Factors as being male, elderly, cigarette smoking, meat/food intake, dietary pattern and MS components at the baseline appear to be the risk factors for developing the MS.

Recent changes in blood pressure levels, hypertension prevalence and treatment rates, and the rate of reaching target blood pressure in the elderly.

Antihypertensive treatment has beneficial effects in the elderly. Surveying the situation of blood pressure in the elderly is quite important for planning strategies to manage elderly hypertensives. The aim of the present study was to investigate changes in blood pressure in the elderly over the past 15 years.As part of a physical check-up program between 2001 and 2015, 29,363 elderly participants (≥65 years of age) attended and were enrolled in the present study. The characteristics of the participants in each year were analyzed cross-sectionally and the results were compared over the 15 years. Changes in blood pressure, hypertension prevalence, and treatment rates, and the rate of reaching target blood pressure in the elderly were investigated.The prevalence of hypertension during the study period increased with increasing participant age. However, both the treatment rate and the rate of reaching target blood pressure in treated subjects improved. The blood pressure of treated hypertensive elderly subjects decreased from 146.1/83.0 to 130.6/75.4 mm Hg, and the reduction was most evident after revision of Japanese Society of Hypertension guidelines regarding target blood pressure in elderly hypertensives. Blood pressure in the entire cohort of elderly subjects decreased from 133.8/78.4 mm Hg in 2001 to 127.9/74.6 mm Hg in 2015.Blood pressure in elderly subjects had decreased over the 15-year study period primarily due to reductions in blood pressure in elderly hypertensive patients on medication. Guidelines for the treatment of hypertension have had a beneficial effect on the management of hypertension in the elderly.

Evaluation of the reduction in central and peripheral arterial blood pressure following an oral glucose load.

The clinical significance of measuring central arterial blood pressure has been recently discussed. Although the postprandial reduction in blood pressure is well known, postprandial changes in central blood pressure have not been intensively studied. The present study investigated differences in the reduction of central and peripheral arterial blood pressure after administration of an oral glucose load.An oral glucose tolerance test (75 g) was performed in 360 participants in our physical checkup program. Brachial and central systolic blood pressures were assessed before and after the glucose load. Central arterial blood pressure was measured noninvasively using an automated device.The mean age was 53.6 ± 8.2 years. Both brachial (127.9 ± 17.7 to 125.0 ± 16.3 mm Hg) and central arterial blood pressures were significantly decreased after an oral glucose load (118.9 ± 17.9 to 112.8 ± 16.8 mm Hg). The reduction in blood pressure was greater in central (7.3 ± 11.5 mm Hg) than in brachial blood pressure measurements (3.4 ± 11.3 mm Hg, P < .001). Extreme blood pressure reduction (>20 mm Hg) was recorded more frequently in central (n = 43, 12.3%) than brachial blood pressure measurements (n = 20, 5.6%).An oral glucose load decreases both central and brachial systolic blood pressure, with more pronounced effects on central blood pressure. Postprandial reductions in blood perfusion of the important organs such as the brain may be underestimated when postprandial BP reduction is assessed using brachial BP measurements.

Carotid intima-media thickness is a novel predictor of new onset of hypertension in normotensive subjects.

Increased carotid intima-media thickness (IMT) in individuals without hypertension might indicate other factors promoting the atherosclerotic process that are often simultaneously clustered in individuals. The present study tested the hypothesis that carotid IMT predicts new onset of hypertension in the normotensive subjects.A total of 867 participants were enrolled from our yearly physical checkup program and their carotid IMT was measured. After a baseline examination, the subjects were followed up for a median of 1091 days with the endpoint being the development of hypertension.At baseline, the carotid IMT value was 0.75 ± 0.16 mm. Hypertension developed in 184 subjects during the follow-up (76.9/1000 person-years). The incidence of hypertension was increased across the tertiles of the carotid IMT value (39.6, 70.0, and 134.5/1000 person-years in the first, second, and third tertiles, respectively, P < .001 by log-rank test). Multivariate Cox-hazard analysis after adjustment identified carotid IMT, taken as a continuous variable, as a significant predictor of new-onset hypertension (hazard ratio = 7.08, 95% confidence interval = 3.06–15.39). Furthermore, multivariate linear regression analyses indicated a significant correlation between the carotid IMT at baseline and yearly increases in systolic blood pressure during the follow-up period (β = 0.189, P < .001).Carotid IMT is an independent predictor of hypertension onset in normotensive subjects. The findings also suggested a close association between increased carotid IMT and blood pressure.

Sociodemographic and economic characteristics of susceptibility to rubella among women preparing for pregnancy in rural China

ObjectivesInfection with rubella virus during pregnancy can result in congenital defects and adverse pregnancy outcomes. The risk of rubella infection is greatly determined by the level of rubella antibodies in the serum. A survey of rubella antibody seronegativity rates was conducted in 780 000 women in rural China who were planning a pregnancy, in order to evaluate the herd susceptibility in different age groups and by high, middle, and low GDP per capita regions. MethodsIn order to evaluate the herd susceptibility to rubella, a nationwide population-based study of rural Chinese women who were planning to have a baby and who were aged 21–49 years was instigated. As a part of the National Free Pre-conception Health Examination Project covering 29 provinces in 2012, a physical check-up program was provided to women who planned to become pregnant within the next 6 months. All medical data were from serological samples tested by ELISA, and the participants’ immunity status was categorized based on levels of rubella antibodies. Economic data were also collected to explore the association between herd susceptibility and socioeconomic characteristics in the women of childbearing age. ResultsA total 264 306 of 782 293 recruited women preparing for pregnancy tested susceptible to rubella (33.79%). The seronegativity rate in women with a history of vaccination was significantly lower than that in women who had not received the vaccination or did not know their vaccination history (23.76%, 33.70%, and 35.68%, respectively). The seronegativity rates were 26.89%, 37.86%, and 32.61% in high, middle, and low GDP per capita areas, respectively. After stratified analysis and adjusting for other factors by multiple logistic regression, the lower seronegativity rates in women in high GDP per capita regions compared to women in middle and low GDP per capita regions remained in the different age groups and subgroups of immunization history. ConclusionsThere is a clear difference in rubella-specific susceptibility among rural women preparing for pregnancy of different sociodemographic and economic backgrounds. The number of rubella-susceptible rural women preparing for pregnancy, especially in relatively low GDP per capita regions in China, was high. Offering rubella vaccination to women who are rubella-susceptible and who plan to become pregnant should become one of the priorities in the field of public health work in China.

PP.30.09] DOSE SALT INTAKE PREDICT THE NEW ONSET OF CHRONIC KIDNEY DISEASE?

Objective: Dietary salt, which is one of the most important modifiable factors in our life style, is associated not only with blood pressure but also with several cardiovascular diseases in a blood pressure–independent manner. We investigated if salt intake predicts new onset of chronic kidney disease (CKD) in the general population. Design and method: Consecutive 8,161 participants (male = 5,168, 55.8 ± 11.3 year-old) with normal estimated glomerular filtration rate (eGFR;> = 60 ml/min/1.73 m2) in our physical health check-up program were enrolled in this study. After baseline examination, participants were followed up (median 1,098 day) with the endpoint being the development of CKD (eGFR<60 ml/min/1.73 m2). Individual salt intake was estimated using spot urine by a previously reported method and GFR was estimated using the Japanese Society of Nephrology formula. Results: Salt intake was 8.9 ± 2.0 g/day in male and 8.6 ± 1.9 g/day in female subjects. eGFR was 80.1 ± 12.7 ml/min/1.73 m2 at baseline, and during the follow-up period, CKD developed in 706 subjects (29.9 per 1000 person-year), with the incidence being more frequent in male than female subjects (31.1 vs. 27.8 per 1000 person-year). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of salt intake for the new CKD was 1.071 (1.034–1.109). Multivariate Cox-hazard analysis adjusted for body mass index, systolic blood pressure, heart rate, uric acid, fasting plasma glucose, low-density lipoprotein cholesterol, triglyceride, hemoglobin, smoking status and eGFR at baseline demonstrated that salt intake was a significant predictor of new onset CKD (HR = 1.077, 95%CI = 1.037–1.119). Univariate and adjusted multivariate liner regression analyses indicated the significant correlation between salt intake at baseline and yearly changes in eGFR (r = -0.081, p < 0.001 and r = -0.069, p < 0.001, respectively). Similar results were obtained in a sub-analysis performed in subjects with normal blood pressure (n = 5,863). Conclusions: Dietary salt intake is significantly associated with the development of CKD and decrease in eGFR in the general population, even in normotensive subjects. These results suggest that salt restriction is beneficial for the prevention of the impairment of kidney function and the development of CKD.

Significance of adjusting salt intake by body weight in the evaluation of dietary salt and blood pressure

The close association between dietary salt and hypertension is well established. However, previous studies generally assessed salt intake without adjustment for body weight. Herein, we investigated the significance of body weight–adjusted salt intake in the general population. The present cross-sectional study included 7629 participants from our yearly physical checkup program, and their salt intake was assessed using a spot urine test to estimate 24-hour urinary salt excretion. Total salt intake increased with increasing body weight. Body weight–adjusted salt intake was greater in participants with hypertension than in those without hypertension. Systolic blood pressure, estimated glomerular filtration rate, and urinary albumin were independently correlated with body weight–adjusted salt intake after adjustment for possible cardiovascular risk factors. Excessive body weight–adjusted salt intake could be related to an increase in blood pressure and hypertensive organ damage. Adjustment for body weight might therefore provide clinically important information when assessing individual salt intake.

Does the ratio of eicosapentaenoic acid to arachidonic acid predict carotid intima-media thickness in the general population?

Purpose: A decrease in the ratio of eicosapentaenoic acid (EPA) to arachidonic acid (AA) (EPA/AA) has been reported to be closely associated with increased incidence of cardiovascular diseases including coronary artery disease and stroke in subjects with high risk of atherothrombotic diseases. Similarly, an increase in the intima-media thickness (IMT) of the common carotid artery is a marker of early stage atherosclerosis and considered to be a predictor of cardiovascular disease. The present study was designed to investigate a possible relationship between the EPA/AA ratio and carotid IMT in the Japanese general population. Methods: A total of 401 participants (men=178, mean age=61.0 years), who visited our hospital for a yearly physical checkup from May 2010 to December 2010, were enrolled. In addition to a routine physical checkup program (routine physical examination, chest X-ray, electrocardiogram [ECG], and laboratory assessment of cardiovascular risk factors), EPA and AA were measured. Participants under medication with EPA were excluded from the study. An image of the common carotid artery was obtained by an ultrasound system and the mean IMT was calculated according to the guideline of Carotid Ultrasound Examination (Neurosonology 2006: 19(2):49-69). Cross-sectional analyses were performed to investigate a relationship between the EPA/AA ratio and carotid IMT. Results: Although the mean value of AA was not different in men and women, the EPA value and the EPA/AA ratio were significantly higher in men than in women (69.6±37.2 vs. 62.4±31.9 μg/ml, and 0.46±0.24 vs. 0.40±0.21, respectively). Strikingly, there was a positive correlation between the mean IMT value and the EPA/AA ratio in univariable regression analysis. However, in multivariable regression analysis, the mean IMT value was correlated with age, male gender, systolic blood pressure and ECG voltage, but not with the EPA/AA ratio. Both the EPA/AA ratio and the mean IMT value were greater in subjects with hypertension as compared to normotensive subjects. In contrast, the mean IMT, but not the EPA/AA ratio, was greater in subjects with than without diabetes mellitus. Conclusions: A decrease in the EPA/AA ratio does not predict increased carotid IMT in the Japanese general population. Significance of the EPA/AA ratio as a maker of clinical atherosclerosis should be further investigated in future by interventional studies.

Trends in age distribution of participants in a self-covered and a public expense-covered health check-up programs in Japan

Objective: In Japan, there are unique facilities (namely Ningen Dock) of health check-up, where asymptomatic participants undergo a medical examination at their own expense. The earlier occurrence of cervical cancer and the concern on screening prompted us compare to the age distribution in the self-covered system with that of free physical check-up programs at public expense. Methods: We analyzed medical records of Japanese women, who underwent gynecological examinations at self-covered expense and at public expense between for the periods 2002-2011 and 2005-2009, respectively, restricting examinee’s age group. Results: For self-covered system, approximately 80% of the overall examinee population was occupied with three age groups 30-39, 40-49 and 50-59. The participants was extremely fewer in the over 60 years age group accounting for 10%, compared to those for the public expense-covered system, the over 60 years age group being 25%. Participant under the age of 30 years seemed to increase in chronological order in both systems. Conclusion: The level of knowledge on sexually transmitted infections may contribute to screening promotion for the younger women, while the elderly over 60 years’ attitudes toward screening may be mainly related to social-economic status and/or public expense support.

Factors associated with brachial-ankle pulse wave velocity in the general population

The present study investigated factors that modify or affect arterial stiffness as assessed by brachial-ankle pulse wave velocity (baPWV) in the general population. Subjects had previously participated in a physical checkup program (n=911), and baPWV and urinary albumin and sodium excretion were also measured. Urine albumin was expressed as the ratio of urine albumin to urine creatinine. Individual salt intake was assessed by estimating 24-h urinary salt excretion and expressed as the ratio of estimated salt intake to body weight. The mean blood pressure and baPWV were 127.1±15.2/77.0±9.5 mm Hg and 15.9±3.3 m s(-1), respectively. Univariate analysis demonstrated that baPWV correlated with various factors including age, blood pressure, electrocardiogram voltage (SV(1)+RV(5)), urine albumin and salt intake. Multivariate regression analysis revealed that electrocardiogram voltage (P<0.001), systolic blood pressure (P<0.0001), urine albumin (P<0.001) and salt intake (P<0.001), independently correlated with baPWV after adjustment for other possible factors. Similar results were obtained for participants not taking any medication. These results suggest that the baPWV value is independently associated with individual salt intake and cardiac and renal damage, and could be a useful procedure for identifying individuals with concealed risk of cardiovascular disease.