Risk Factors In Japan Research Articles

Risk factors of peritoneal dialysis-related peritonitis in the Japan Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Peritoneal dialysis (PD)-related peritonitis is a major complication of PD. Wide variations in peritonitis prevention, treatment strategies and consequences are seen between countries. These between-country differences may result from modifiable risk factors and clinical practices. A total of 1225 Japanese PD patients were included and prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study phase 1 (2014-2018) and phase 2 (2018-2022). Associations between PD-related peritonitis and various risk factors were assessed by Cox proportional hazards survival models. During follow-up (median 1.52years), 539 peritonitis episodes were experienced by 364 patients. The country crude peritonitis rate was 0.27 episodes/patient-year. In the fully adjusted model, noticeable patient-level factors associated with experiencing any peritonitis included age {hazard ratio [HR] 1.07 per 5-year increase [95% confidence interval (CI) 1.01-1.14]}, serum albumin level [HR 0.63 per 1g/dl higher (95% CI 0.48-0.82)] and continuous ambulatory peritoneal dialysis (PD) [HR 1.31 versus automated PD (95% CI 1.05-1.63)]. The adoption of antibiotic prophylaxis practice at the time of PD catheter insertion [HR 0.63 (95% CI 0.51-0.78)] or when having complicated dental procedures [HR 0.74 (95% CI 0.57-0.95)] or lower endoscopy [HR 0.69 (95% CI 0.54-0.89)] were associated with lower hazards of any peritonitis, while a routine facility practice of having more frequent regular medical visits was associated with a higher hazard. Identification of risk factors in Japan may be useful for developing future versions of guidelines and improving clinical practices in Japan. Investigation of country-level risk factors for PD-related peritonitis is useful for developing and implementing local peritonitis prevention and treatment strategies.

Population attributable fraction of low birth weight risk factors in Japan

Population attributable fraction of low birth weight risk factors in Japan

Economic burden of cancer attributable to modifiable risk factors in Japan.

Controlling avoidable causes of cancer may save cancer-related healthcare costs and indirect costs of premature deaths and productivity loss. This study aimed to estimate the economic burden of cancer attributable to major lifestyle and environmental risk factors in Japan in 2015. We evaluated the economic cost of cancer attributable to modifiable risk factors from a societal perspective. We obtained the direct medical costs for 2015 from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, and estimated the indirect costs of premature mortality and of morbidity due to cancer using the relevant national surveys in Japan. Finally, we estimated the economic cost of cancer associated with lifestyle and environmental risk factors. The estimated cost of cancer attributable to lifestyle and environmental factors was 1,024,006 million Japanese yen (¥) (8,460 million US dollars [$]) for both sexes, and ¥673,780 million ($5,566 million) in men and ¥350,226 million ($2,893 million) in women, using the average exchange rate in 2015 ($1 = ¥121.044). A total of ¥285,150 million ($2,356 million) was lost due to premature death in Japan in 2015. Indirect morbidity costs that could have been prevented were estimated to be ¥200,602 million ($1,657 million). Productivity loss was highest for stomach cancer in men (¥28,735 million/$237 million) and cervical cancer in women (¥24,448 million/$202 million). Preventing and controlling cancers caused by infections including Helicobacter pylori, human papillomavirus and tobacco smoking will not only be life-saving but may also be cost-saving in the long run.

Long-Term Projections of Cancer Incidence and Mortality in Japan and Decomposition Analysis of Changes in Cancer Burden, 2020-2054: An Empirical Validation Approach.

The aim of this study was to project new cancer cases/deaths forward to 2054, and decompose changes in cancer cases/deaths to assess the impact of demographic transitions on cancer burden. We collected data on cancer cases/deaths up to 2019, empirically validated the projection performance of multiple statistical models, and selected optimal models by applying time series cross-validation. We showed an increasing number of new cancer cases but decreasing number of cancer deaths in both genders, with a large burden attributed to population aging. We observed the increasing incidence rates in most cancer sites but reducing rates in some infection-associated cancers, including stomach and liver cancers. Colorectal and lung cancers were projected to remain as leading cancer burdens of both incidence and mortality in Japan over 2020-2054, while prostate and female breast cancers would be the leading incidence burdens among men and women, respectively. Findings from decomposition analysis require more supportive interventions for reducing mortality and improving the quality of life of Japanese elders. We emphasize the important role of governments and policymakers in reforming policies for controlling cancer risk factors, including oncogenic infections. The rapid increase and continued presence of those cancer burdens associated with modifiable risk factors warrant greater efforts in cancer control programs, specifically in enhancing cancer screening and controlling cancer risk factors in Japan.

The effect of casirivimab with imdevimab on disease progression in nonsevere COVID-19 patients in a single hospital in Japan.

BackgroundRecent randomized trials have revealed that neutralizing monoclonal antibodies can reduce disease progression in mild–moderate COVID‐19 patients. However, no studies have investigated the effect of neutralizing monoclonal antibodies on clinical outcomes in Japan.MethodsA single‐center retrospective and prospective cohort study was conducted. All consecutive febrile nonsevere COVID‐19 patients with at least one risk factor were included. The primary outcome was progression to severe COVID‐19. Severe COVID‐19 cases were defined as patients requiring oxygen therapy and dexamethasone. The differences in the primary outcomes between the patients who were treated with casirivimab with imdevimab (treatment group) and those who were not (control group) were compared using the chi‐squared test.ResultsA total of 128 patients were included. Of those, the mean age was 53.6 years old (SD 9.9), and 52 (40.6%) were women. Fifty‐three patients were treated with casirivimab with imdevimab, and 75 patients were given the standard treatment only. The primary outcome occurred in eight (15.1%) of the 53 patients in the treatment group and 33 (44.0%) of the 75 patients in the control group (odd ratio [OR] 0.23, 95% CI 0.09 to 0.55). The multivariate analysis revealed that the use of casirivimab with imdevimab (OR 0.21, 95% CI 0.08 to 0.54) was the only independent risk factor associated with progression to severe COVID‐19. No patients died during hospitalization in either group.ConclusionSimilar to other countries, casirivimab with imdevimab significantly reduced disease progression in early nonsevere COVID‐19 patients with fever and risk factors in Japan.

Pelvic organ prolapse and Japanese lifestyle: prevalence and risk factors in Japan.

Little is known about the prevalence of pelvic organ prolapse (POP). We aimed to evaluate the prevalence of POP and identify its risk factors in Japan. This was a single-centre, cross-sectional study. We recruited Japanese women seen for a Pap smear from July 2018 through May 2019. After providing their informed consent, subjects were asked to complete questionnaires. Pelvic organ support was assessed using the POP quantification (POP-Q) system by an examiner. Logistic regression analyses were conducted to identify risk factors for POP. There were 1032 women aged 21 to 84years. The distribution of POP-Q stage was stage 0, 38.0%; stage I, 45.0%; stage II, 16.4%; stage III, 0.6%; and stage IV, 0%. Rates (95% confidence interval [CI]) of stage II or greater in each age group were 6.6% (2.4-10.8) in 20s-30s; 17.6% (13.3-21.9) in 40s; 17.1% (12.9-21.3) in 50s; 18.0% (12.6-23.4) in 60s; and 28.7% (19.6-37.9) in 70s and over. Multivariate analysis revealed the following risk factors for POP, with odds ratio (95% CI): body mass index [BMI] ≥ 25kg/m2, 1.63 (1.05-2.51); BMI < 18.5kg/m2, 0.40 (0.17-0.94); hysterectomy, 4.09 (1.55-10.80); ≥ 3 vaginal deliveries, 2.26 (1.19-4.28); and ≥ 1 cup of coffee per day, 0.63 (0.43-0.92). Among Japanese women undergoing routine gynaecological examinations, 17.1% (14.7-19.5) had POP-Q stage II or greater. Overweight, hysterectomy and ≥ 3 vaginal deliveries increased the risk for POP, whereas underweight and daily coffee consumption decreased it.

Estimation of Health Risk Posed by Road Traffic Noise in Japan Based on the Environmental Noise Guidelines for the European Region

Traffic noise exposure is associated with adverse health effects such as environmental sleep disorder, ischaemic heart disease (IHD), stroke and diabetes. The health risks posed by traffic noise were estimated to be quite high in European countries. However, in Japan, no estimation has ever been conducted. In the present study, we estimated the health risk posed by road traffic noise in Japan. We estimated the risks of environmental sleep disorder (high sleep disturbance) and IHD caused by road traffic noise in Japan as of 2015 on the basis of existing noise-exposure estimates, vital statistics of deaths, and patient survey with exposure-response relationships proposed by the Environmental Noise Guidelines for the European Region issued in 2018. We employed old information on noise exposure in 1994 because it is the only information currently available in Japan. We also estimated the health risks of noise exposure levels that were equivalent to the Japanese environmental quality standards. The estimated numbers of patients with environmental sleep disorder and IHD caused by road traffic noise were approximately 1,200,000 and 9,000, respectively. The estimated number of mortalities from IHD was approximately 1,700. The noise exposure level equivalent to the Japanese noise standards caused a lifetime mortality rate of more than 10-2, which was extremely high as an environmental health risk. As in European countries, road traffic noise was one of the most important environmental risk factors in Japan. However, the current Japanese noise standards are insufficient for the protection of public health.

Risk factors for anorexia nervosa and bulimia nervosa in Japan and compared to a U.S. sample.

This study provides the first systematic investigation of environmental exposure to putative psychosocial risk factors for eating disorders in individuals with AN and BN in Japan. It also provides a comparison of risk factors for the development of AN and BN in Japan versus the United States. Participants in Japan were 96 women with a current DSM-IV AN or BN primary diagnosis (AN, n = 60; BN, n = 36) and 57 women with no current psychiatric diagnosis (NC group). Participants in the United States were 137 women with a current DSM-IV AN or BN primary diagnosis (AN-U.S., n = 71; BN-U.S., n = 66). A standardized semi-structured interview retrospectively assessed exposure to risk factors prior to first symptom onset, which were analyzed using General Linear Model analyses. Perfectionism and negative affectivity, family relationship issues, and, to a lesser degree, parental psychopathology predicted the emergence of AN and BN in Japan. Physical and sexual abuse and family eating and weight concerns were not significant risk factors in Japan. Compared to their respective diagnostic U.S. groups, the Japanese AN group reported higher levels of individual mental health factors and lower levels of family dieting and family overweight, and the Japanese BN group reported higher levels on individual mental health factors, lower exposure to problems with their parents, and lower exposure to family weight and eating concerns. These country-specific data from Japan contribute to an increasingly nuanced and global understanding of risk factors for eating disorders.

Abstract WP554: Nationwide Survey of CADASIL in Japan

Objectives: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is one of the common type of hereditary small vessel disease. The clinical presentation of CADASIL has been reported as varies, and there may exist the racial gap between Asian and Caucasian people. However, the clinical features of CADASIL in Japan is still unclear. This study aimed to elucidate the epidemiological and clinical features of CADASIL based on the nationwide survey in Japan. Methods: Target subjects were patients with CADASIL who had visited the certified hospitals (totally 1, 448 hospitals) by Japanese Society of Neurology and/or Japan Stroke Society in 2016. This study consisted of two steps surveys; patients with CADASIL were identified genetically by the first questionnaire, and their clinical features were assessed by the second questionnaire. Selected 6 hospitals registered the data of patients with CADASIL to REDCap system. Results: Based on the Japanese criteria (Mizuta et al. 2017), 88 patients (50 males and 38 females) with definite CADASIL were reported. Mean age at symptom onset was 49.4 years. Late onset (&gt; 60 years) patients were 15 (17.0%), episode of migraine was detected in 26 patients (29.5%), and patients who had vascular risk factor(s) were 33 (37.5%). Stroke-like episodes with neurological signs were detected in 59 patients (67%), cognitive impairment in 31 patients (35.2%), pyramidal sign in 41 patients (46.6%), and pseudobulbar palsy in 20 patients (22.7%). Abnormal deep white matter lesions (WMLs) were detected in 85 patients (96.6%), WMLs extending to anterior temporal pole in 73 patients (83.0%), and cerebral microbleeds in 41 patients (46.6%). Conclusions: Although, CADASIL is characterized by early onset of stroke and without vascular risk, there were more than a few CADASIL patients with late onset and vascular risk factors in Japan.

Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015

SummaryBackgroundJapan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regional variations in disease burden. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides a comprehensive, comparable framework. We used data from GBD 2015 with the aim to quantify the burden of disease and injuries, and to attribute risk factors in Japan at a subnational, prefecture-level.MethodsWe used data from GBD 2015 for 315 causes and 79 risk factors of death, disease, and injury incidence and prevalence to measure the burden of diseases and injuries in Japan and in the 47 Japanese prefectures from 1990 to 2015. We extracted data from GBD 2015 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) in Japan and its 47 prefectures. We split extracted data by prefecture and applied GBD methods to generate estimates of burden, and attributable burden due to known risk factors. We examined the prefecture-level relationships of common health system inputs (eg, health expenditure and workforces) to the GBD outputs in 2015 to address underlying determinants of regional health variations.FindingsLife expectancy at birth in Japan increased by 4·2 years from 79·0 years (95% uncertainty interval [UI] 79·0 to 79·0) to 83·2 years (83·1 to 83·2) between 1990 and 2015. However, the gaps between prefectures with the lowest and highest life expectancies and HALE have widened, from 2·5 to 3·1 years and from 2·3 to 2·7 years, respectively, from 1990 to 2015. Although overall age-standardised death rates decreased by 29·0% (28·7 to 29·3) from 1990 to 2015, the rates of mortality decline in this period substantially varied across the prefectures, ranging from −32·4% (−34·8 to −30·0) to −22·0% (−20·4 to −20·1). During the same time period, the rate of age-standardised DALYs was reduced overall by 19·8% (17·9 to 22·0). The reduction in rates of age-standardised YLDs was very small by 3·5% (2·6 to 4·3). The pace of reduction in mortality and DALYs in many leading causes has largely levelled off since 2005. Known risk factors accounted for 34·5% (32·4 to 36·9) of DALYs; the two leading behavioural risk factors were unhealthy diets and tobacco smoking in 2015. The common health system inputs were not associated with age-standardised death and DALY rates in 2015.InterpretationJapan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment.FundingBill & Melinda Gates Foundation, Japan Ministry of Education, Science, Sports and Culture, Japan Ministry of Health, Labour and Welfare, AXA CR Fixed Income Fund and AXA Research Fund.

Trends in perinatal mortality and its risk factors in Japan: Analysis of vital registration data, 1979\u20132010

As Japan has achieved one of the lowest perinatal mortality rates (PMR), our study aims to estimate trends in and risk factors for perinatal mortality among singleton births in Japan. We used Japanese vital registration data to assess trends in and risk factors for perinatal outcomes between 1979 and 2010. Birth and death registration data were merged. An autoregressive integrated moving average model was fitted separately by sex to the PMR and the proportion of stillbirths. A multilevel Poisson regression model was used to estimate risk factors for perinatal mortality. Between 1979 and 2010 there were 40,833,957 pregnancies and 355,193 perinatal deaths, the PMR decreased from 18.86 per 1,000 all births to 3.25 per 1,000 all births, and the proportion of stillbirths increased from 83.6% to 92.1%. Key risk factors for perinatal mortality were low or high birth weight, prematurity and post maturity, and being from poorer or unemployed families. A higher proportion of excess perinatal deaths could be averted by effective policies to prevent stillbirths and improved research into their interventions and risk factors. As the cost and challenge of maintaining perinatal mortality gains increases, policies need to be targeted towards higher risk groups and social determinants of health.

Evaluation of Medical Costs of Kidney Diseases and Risk Factors in Japan

Background: Kidney (renal) diseases and dialysis are among the most costly disorders and represent a worldwide burden. In this study, we evaluate the medical costs for individuals with kidney diseases and risk factors for the diseases in Japan. Data and Methods: The dataset used contained 113,979 medical checkups and 3,172,066 medical cost records obtained from 48,022 individuals in one health insurance society. The sample period was April 2013 to March 2016. We evaluated the distribution of all medical costs, and those of kidney diseases specifically. Then the power transformation Tobit model was used to remove the effects of other variables. Finally, a probit analysis was used to analyze the risk factors. Results: In 0.25% of all cases, individuals were diagnosed with kidney diseases. An individual with kidney disease cost 14.5 times more than those without kidney disease. If the diseases progressed into chronic kidney disease (CKD), the medical costs increased substantially. Even disregarding various characteristics of individuals, this conclusion did not vary. We found important risk factors included diabetes and blood pressure problems. In particular, an individual with both factors had a high probability of developing kidney disease. Conclusion: Kidney diseases are much costlier than other diseases. Screening high-risk individuals, educating patients, and ensuring that treatment begins at an early stage are critically important to controlling medical costs. Limitations: The dataset was observatory, and the sample period was only 3 years.

Brachial-Ankle PWV: Current Status and Future Directions as a Useful Marker in the Management of Cardiovascular Disease and/or Cardiovascular Risk Factors.

Since 2001, brachial-ankle pulse wave velocity (brachial-ankle PWV) measurement has been applied for risk stratification of patients with atherosclerotic cardiovascular disease and/or its risk factors in Japan. Measurement of the brachial-ankle PWV is simple and well standardized, and its reproducibility and accuracy are acceptable. Several cross-sectional studies have demonstrated a significant correlation between the brachial-ankle PWV and known risk factors for cardiovascular disease; the correlation is stronger in subjects with cardiovascular disease than in those without cardiovascular disease. We conducted a meta-analysis, which demonstrated that the brachial-ankle PWV is an independent predictor of future cardiovascular events. Furthermore, the treatment of cardiovascular risk factors and lifestyle modifications have been shown to improve the brachial-ankle PWV. Thus, at present, brachial-ankle PWV is close to being considered as a useful marker in the management of atherosclerotic cardiovascular disease and/or its risk factors.

Epidemiology of domestically acquired hepatitis E virus infection in Japan: assessment of the nationally reported surveillance data, 2007-2013.

In recent years, there has been an increase in the number of reported hepatitis E virus (HEV) infections from developed countries. To describe recent trends in notification and potential risk groups and risk factors in Japan, HEV infection cases and demographic, food consumption, clinical and laboratory data reported during 2007-2013 were analysed. In total, 530 HEV infections were reported during 2007-2013. Amongst 462 domestic cases, the mean age was 56.5 years (sd 13.9) and 80.1 % were male. Forty-three cases (9.3 %) were asymptomatic, amongst which 11 were detected from blood donations. Whilst ∼50 cases were reported annually during 2007-2011, the number of reported cases increased to 121 in 2012 and 126 in 2013. The increase was characterized by a rise in the number of domestic, symptomatic cases (P = 0.05) and cases confirmed by anti-HEV IgA detection (P < 0.01). HEV genotypes G3 and G4 were consistently dominant. The major suspected source of infection was food-borne, and the major suspected foods were pig, wild boar and deer meat. The observed increase during 2012-2013 was most likely due to the coverage of the anti-HEV IgA assay by the National Health Insurance system in Japan in October 2011 and its acceptance for surveillance purposes. However, the increase was not associated with detection of asymptomatic cases. Moreover, males aged 50-69 years remained as the high-risk group, and pork and other meats continued to be the most suspected items. Our findings indicated that HEV infection is an emerging and important public health concern in Japan.

The relationship between religiosity and cardiovascular risk factors in Japan: a large–scale cohort study

The goal of this study was to examine the relationship between religiosity and cardiovascular risk factors in a Japanese population. A retrospective cohort study was conducted involving individuals who underwent annual health check–ups at St. Luke's International Hospital from 2005 to 2010. Data collected included self–reported demographics, clinical information, and health habits, as well as religiosity, baseline examination, and laboratory measures. We conducted multivariable regression analyses to examine the associations between religiosity and cardiovascular risk factors at baseline and longitudinally. The analyses were performed in 2012. A total of 36,965 participants were enrolled, and 13,846 (37.8%) reported being at least somewhat religious. Compared with those who were not religious at baseline, religious participants (n = 3685) were less likely to be current smokers (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.53–0.67) and to report excessive alcohol consumption (OR, 0.74; 95% CI, 0.67–0.82), and more likely to exercise at least three times a week (OR, 1.27; 95% CI,1.16-1.39) and to be obese (OR, 1.32; 95% CI, 1.19–1.47). There were no significant differences in the rate of hypertension, diabetes mellitus, or dyslipidemia prevalence. In longitudinal data analyses, religiosity was associated with a lower likelihood of smoking and excessive alcohol consumption, and a higher likelihood of regular exercise and a lower incidence of diabetes over time. Individuals who were more religious were significantly more likely to have favorable health habits and fewer cardiovascular risk factors, except for a higher prevalence of overweight/obesity at baseline. Religiosity was also associated with better health habits over time and less likely to be associated with future diabetes but not with blood pressure or lipid levels.

Burden of Disease in Japan: Using National and Subnational Data to Inform Local Health Policy

The Global Burden of Disease (GBD) study has been instrumental in guiding global health policy development since the early 1990s. The GBD 2010 project provided rich information about the key causes of mortality, disability-adjusted life years, and their associated risk factors in Japan and provided a unique opportunity to incorporate these data into health planning. As part of the latest update of this project, GBD 2013, the Japanese GBD collaborators plan to update and refine the available burden of disease data by incorporating sub-national estimates of the burden of disease at the prefectural level. These estimates will provide health planners and policy makers at both the national and prefectural level with new, more refined tools to adapt local public health initiatives to meet the health needs of local populations. Moreover, they will enable the Japanese health system to better respond to the unique challenges in their rapidly aging population and as a complex combination of non-communicable disease risk factors begin to dominate the policy agenda. Regional collaborations will enable nations to learn from the experiences of other nations that may be at different stages of the epidemiological transition and have different exposure profiles and associated health effects. Such analyses and improvements in the data collection systems will further improve the health of the Japanese, maintain Japan's excellent record of health equity, and provide a better understanding of the direction of health policy in the region.

A web-based survey of erection hardness score and its relationship to aging, sexual behavior, confidence, and risk factors in Japan.

IntroductionErection hardness is an elemental component of men's sexual quality of life that can be easily measured by the Erection Hardness Score (EHS). However, there are few published data regarding EHS, and there is little understanding of its relationships to aging, men's sexual behavior, sexual confidence, and risk factors in Japan.AimTo assess EHS and how it correlates to aging, sexual behaviors, sexual self-confidence, and risk factors in a Japanese population database.MethodsA web-based cross-sectional nationwide survey conducted between March and May 2009 in Japan.Main Outcome MeasuresEHS, lifestyle factors, comorbidities, general health, sexual confidence, frequency of sexual behaviors, and attitudes toward treatment of erectile dysfunction (ED).ResultsA total of 7,710 men with a mean age of 39.3 ± 13.0 years participated in this survey. In 6,528 participants who were not using phosphodiesterase type 5 inhibitors, 3,540 (54.2%) had EHS ≤ 3 and 1,196 (18.3%) had EHS ≤ 2. We found a significant age-dependent decrease in EHS, sexual confidence, and frequency of sexual activities. Sexual confidence was strongly associated with higher EHS but was also associated with older age groups, presence of offspring, awareness of better general health, and greater frequency of sexual activity. In age-adjusted multivariate logistic regression, risk factors for a lower EHS (defined as EHS ≤ 2) were heavy smoking, which was defined as more than two packs per day (odds ratio [OR], 1.7) or a history of metabolic syndrome (OR, 1.4), hypertension (OR, 1.2), and diabetes mellitus (OR, 1.4).ConclusionsEHS correlates to various elements, such as aging, sexual behaviors, sexual confidence, and ED-related risk factors, and can be a valuable tool in clinical practice for monitoring and treating ED and thereby improving the quality of life for men and their sexual partners. Kimura M, Shimura S, Tai T, Kobayashi H, Baba S, Kano M, and Nagao K. A web-based survey of Erection Hardness Score and its relationship to aging, sexual behavior, confidence, and risk factors in Japan. Sex Med 2013;1:76–86.

Secular Trends in Cardiovascular Disease and Its Risk Factors in Japanese

Background— Changes in lifestyle and advances in medical technology during the past half century are likely to have affected the incidence and mortality of cardiovascular disease and the prevalence of its risk factors in Japan. Methods and Results— We established 5 cohorts consisting of residents aged ≥40 years in a Japanese community, in 1961 (n=1618), 1974 (n=2038), 1983 (n=2459), 1993 (n=1983), and 2002 (n=3108), and followed up each cohort for 7 years. The age-adjusted incidence of stroke decreased greatly, by 51% in men and by 43% in women, from the 1960s to the 1970s, but this decreasing trend slowed from the 1970s to the 2000s. Among the stroke subtypes, ischemic stroke in both sexes and intracerebral hemorrhage in men showed a similar pattern. Stroke mortality decreased as a result of the decline in incidence and a significant improvement in survival rate. Although the incidence of acute myocardial infarction did not change in either sex, disease mortality declined slightly in women. From the 1960s to the 2000s, blood pressure control among hypertensive individuals improved significantly and the smoking rate decreased, but the prevalence of glucose intolerance, hypercholesterolemia, and obesity increased steeply. Conclusions— Our findings suggest that in Japanese, the decreasing trends in the incidence of ischemic stroke have recently slowed down, and there has been no clear change in the incidence of acute myocardial infarction, probably because the benefits of hypertension control and smoking cessation have been negated by increasing metabolic risk factors.

A review of statin use in patients with acute coronary syndrome in Western and Japanese populations

Early high-dose statin therapy to reduce low-density lipoprotein cholesterol (LDL-C) is associated with improved cardiovascular outcomes in Western patients with stable coronary heart disease or acute coronary syndromes (ACS), but many patients remain undertreated and do not attain LDL-C treatment goals. Early statin therapy has also been shown to improve cardiovascular outcomes in Japanese patients with ACS, and pretreatment with high-dose statin prior to percutaneous coronary intervention has been shown to reduce cardiovascular events in these patients. As is the case in Western populations, many Japanese patients may be undertreated and a residual cardiovascular risk remains. While differences in treatment practice, dosing and genetic factors exist between Japan and Western countries, similarities are also evident when Japanese statin studies are compared with those performed in Western populations. With the increasing prevalence of cardiovascular risk factors in Japan, aggressive statin treatment may be beneficial in achieving optimal cardiovascular outcomes.

Abstract WP192: Secular Trends in the Incidence, Mortality and Survival Rates of Cardiovascular Disease in a General Japanese Population: the Hisayama Study, 1961-2009

Background: Changes in lifestyle and advances in medical technology during the past half century have been likely to affect the incidence and mortality of cardiovascular diseases and the prevalence of their risk factors in Japan. Methods: We established 5 cohorts consisting of residents of the town of Hisayama, Fukuoka, Japan, aged 40 years or older without a history of cardiovascular disease in 1961, 1974, 1983, 1993, and 2002. Each cohort was followed up for 7 years. Results: The age-adjusted incidence and mortality rates of ischemic stroke decreased significantly in men and women over the past half century. These decreasing trends were the greatest in the earlier period (from the 1960s to the 1970s) and slowed down in the recent period (from the 1980s to the 2000s). The incidence and mortality of intracerebral hemorrhage decreased significantly in men but not in women. The incidence and mortality of coronary heart disease decreased in women, but did not show a clear change in men. Five-year survival rates of stroke and acute myocardial infarction increased significantly with time. While the prevalence of hypertension did not show a drastic secular change, the proportion of individuals with antihypertensive treatment increased consistently, and mean systolic and diastolic blood pressures among hypertensive participants significantly decreased over the study period. On the other hand, the prevalence of glucose intolerance, hypercholesterolemia, and obesity increased steeply. Conclusions: The incidence and mortality rates of ischemic stroke in both sexes, intracerebral hemorrhage in men, and coronary heart disease in women decreased significantly, probably owing to better management of hypertension. However, the decreasing trends in ischemic stroke slowed down recently and there was no clear change for coronary heart disease in men, probably because the benefits of hypertension control were negated by increasing prevalence of metabolic risk factors. In addition to strict control of hypertension, urgent management of metabolic disorders is needed for further prevention of cardiovascular disease in Japan.