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Yoshida Y.,Iwate Medical University | Kawamura K.,Iwate Health Service Association | Okayama A.,The First Anti tuberculosis Association
Circulation Journal | Year: 2010

Background: Plasma B-type natriuretic peptide (BNP) levels are confounded by renal dysfunction, so this study examined whether plasma BNP might be a reliable biomarker of the onset of cardiovascular (CV) events in a population-based cohort with impaired renal function. Methods and Results: Baseline data, including plasma BNP, serum creatinine, and urinary protein levels, were determined in participants from a community-based population. Estimated glomerular filtration rate (eGFR) was calculated, and chronic kidney disease (CKD) was defined as either: eGFR lt;60 ml·min1·1.73 m2 and/or proteinuria (CKD definition-1) or GFR lt;60 ml·min1·1.73 m2 (CKD definition-2). The CV endpoint was surveyed prospectively. The cohorts were followed for 5,275 person-years for CKD definition-1, and for 4,350 person-years for CKD definition-2. The CV event-free survival rate in the highest BNP quartile in either CKD definition was the lowest among the quartile groups (P<0.001). In multivariate Cox regression models adjusted by traditional CV risk factors and atrial fibrillation, relative risk (RR) for CV events was significantly higher in the highest BNP quartile compared with the lowest BNP quartile (CKD definition-1, RR 3.51, P<0.01: CKD definition-2, RR 4.67, both P<0.01). Conclusions: Plasma BNP level provides strong predictive information about the future onset of CV events in CKD subjects selected from the general population.


PubMed | Morioka University, First Institute of Health Service, Iwate University, Iwate Health Service Association and Iwate Medical University
Type: Journal Article | Journal: Atherosclerosis | Year: 2014

Although a higher heart rate is known to be a risk factor for cardiovascular disease (CVD) events, there have been no reports concerning bradycardia. Whether lower and higher resting pulse rates (RPRs) are associated with cardiovascular risk was investigated in subjects from a community-based, prospective cohort study.After subjects with atrial fibrillation, subjects with a history of CVD, and subjects receiving antihypertensive treatment were excluded, 17,766 subjects (5958 men), aged 40-79 (mean 61.5) years, were analyzed. The RPR at baseline was categorized into four groups (RPR<60, 60-69.5, 70-79.5, 80 beats per minute (bpm)) using the average value of two consecutive measurements. The endpoint was set as the composite outcome of myocardial infarction, stroke, or sudden death.During a mean follow-up of 5.6 years, there were 213 events in men and 186 events in women. In Cox regression models, increased risks of CVD were found in the men group with RPR<60bpm, as well as the group with RPR80bpm, compared with the reference group with RPR 60-69.5bpm (hazard ratio [HR]=1.73, p=0.005 and HR=2.01, p<0.001). These increased risks were found even when adjusted for age and other CVD risk factors (HR=1.55, p=0.026 with RPR<60bpm and HR=1.72, p=0.009 with RPR80bpm). In women, there were no significant associations between RPR and CVD risk.Bradycardia, as well as a higher pulse rate, may be an independent risk factor for future cardiovascular events in apparently healthy men.


Tanno K.,Iwate Medical University | Okamura T.,Japan National Cardiovascular Center Research Institute | Ohsawa M.,Iwate Medical University | Onoda T.,Iwate Medical University | And 6 more authors.
Clinica Chimica Acta | Year: 2010

Background: We compare the direct homogeneous low-density lipoprotein cholesterol (LDL-C) assay with the Friedewald formula (FF) for determination of LDL-C in a large community-dwelling population. Methods: A total of 21,194 apparently healthy subjects aged 40 to 79 years with triglyceride (TG) concentrations < 4.52 mmol/l were enrolled. LDL-C were directly measured by the enzymatic homogeneous assay (LDL-C (D)) and also estimated by the FF (LDL-C (F)). Paired t-test, Pearson's correlation coefficient and linear regression analysis were performed and the concordances of the National Cholesterol Education Program (NCEP) risk category were estimated. Results: Both in fasting (n. = 3270) and nonfasting samples (n. = 17,924), LDL-C (D) highly correlated with LDL-C (F): r= 0.971 and 0.955, respectively. Concordant results for NCEP categories were 84.8% for fasting samples and 80.1% for nonfasting samples. However, the bias between the 2 measurements increased in samples with TG concentrations > 1.69 mmol/l, especially in nonfasting samples. Conclusions: The results showing less variability of the direct LDL-C assay than that of the FF in nonfasting samples suggest that epidemiological studies can use LDL-C measured by the direct assay both in fasting and nonfasting samples. © 2010 Elsevier B.V.


Yokokawa H.,Fukushima Medical University | Yasumura S.,Fukushima Medical University | Tanno K.,Iwate Medical University | Ohsawa M.,Iwate Medical University | And 10 more authors.
Journal of Atherosclerosis and Thrombosis | Year: 2011

Aim: To examine and compare the predictive value of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C and LDL-C/HDL-C ratios for future cardiovascular outcomes in the general Japanese population. Methods: A total of 24,566 eligible participants aged 18 years or older, without cardiovascular disease, were enrolled through multiphase health screening and divided into quartile groups based on lipoprotein levels or ratios. Primary endpoints of the study were definitive acute myocardial infarction (AMI) and ischemic stroke, and cases of sudden death with unknown causes were not included. We used Cox proportional hazard models to examine the relationships between the quartiles and incidences of AMI or ischemic stroke, adjusting for traditional risk factors. Results: Mean age was 63.7 years for males and 60.7 years for females. Mean follow-up period was 2.7 years, and 40 cases of AMI and 182 cases of ischemic stroke were recorded. The hazard ratio (HR) for AMI was significantly higher in the top quartile of the LDL-C/HDL-C ratio and LDL-C levels, and third quartile of TC among male participants. The HR of male participants with a LDL-C/HDL-C ratio of 2.6 or higher was significantly higher than other quartiles. No association between lipoprotein levels or their ratio quartiles and ischemic stroke was seen for either sex after adjusting for risk factors. Conclusions: Our results indicated that the LDL-C/HDL-C ratio is an independent predictor for AMI, and the importance of better management of cardiovascular risks among people with high LDLC/HDLC ratios for the prevention of future cardiovascular disease.


Makita S.,Iwate Medical University | Abiko A.,Iwate Medical University | Nagai M.,Iwate Medical University | Yonezawa S.,Iwate Health Service Association | And 3 more authors.
Metabolism: Clinical and Experimental | Year: 2013

Background: The risk of cardiovascular diseases is lower among moderate alcohol drinkers than among both nondrinkers and heavy drinkers. However, factors that can account for the U-shaped or J-shaped relationship between daily alcohol consumption and incident cardiovascular diseases remain obscure. Purpose: The present cross-sectional study investigated the relationship between alcohol consumption and serum adiponectin levels. Method: Total adiponectin was measured in 527 males participating in health check-up programs (age range 40-86 years, mean 60.5 years). Based on questionnaire responses, alcohol intake was categorized into three groups: none or occasional (A1); < 50 g/day and ≥ 3 days/week (A2); and ≥ 50 g/day and ≥ 3 days/week (A3). Results: No significant differences in adiponectin levels were observed among the three alcohol consumption groups of subjects without the metabolic syndrome (MetS). In subjects with the MetS, the adiponectin level was significantly higher in the A2 (moderate drinker) group than in both the A1 and A3 groups. MetS subjects in group A2 had higher HDL-C levels than those in A1, but levels in group A3 were not significantly different from those in group A2. Conclusion: An increased adiponectin level in moderate alcohol drinkers who have MetS may contribute to the U-shaped relationship between alcohol consumption and risk of cardiovascular events, in addition to the involvement of HDL-C. © 2013 Elsevier Inc.


Ohsawa M.,Iwate Medical University | Tanno K.,Iwate Medical University | Itai K.,The First Institute of Health Service | Turin T.C.,University of Calgary | And 15 more authors.
Circulation Journal | Year: 2013

Background:Whether estimated glomerular filtration rate (eGFR) calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Study equation (eGFRCKDEPI) improves risk prediction compared to that calculated using the Modification of Diet in Renal Disease (MDRD) study equation (eGFRMDRD) has not been examined in a prospective study in Japanese people. Methods and Results:Participants (n=24,560) were divided into 4 stages (1, ≥90; 2, 60-89 (reference); 3a, 45-59; -2) according to eGFRCKDEPI or eGFRMDRD. Endpoints were all-cause death, myocardial infarction (MI) and stroke. Area under the receiver operating characteristic curves (95% confidence intervals) for predicting all-cause death, MI and stroke by eGFRCKDEPI vs. eGFRMDRD were 0.680 (0.662-0.697) vs. 0.582 (0.562-0.602); 0.718 (0.665-0.771) vs. 0.642 (0.581-0.703); and 0.656 (0.636-0.676) vs. 0.576 (0.553-0.599), respectively. Multivariate-adjusted Cox regression and Poisson regression analysis results were similar for adjusted incidence rates and adjusted hazard ratios in each corresponding stage between the 2 models and no differences were found in model assessment parameters. Net reclassification improvement (NRI) for predicting all-cause death, MI and stroke were estimated to be 6.7% (P<0.001), -1.89% (P=0.029) and -0.20% (P=0.421), respectively. Conclusions:Better discrimination was achieved using eGFRCKDEPI than eGFRMDRD on univariate analysis. NRI analysis indicated that the use of eGFRCKDEPI instead of eGFRMDRD offered a significant improvement in reclassification of death risk.


Ando A.,Iwate Medical University | Ohsawa M.,Iwate Medical University | Yaegashi Y.,Iwate Medical University | Sakata K.,Iwate Medical University | And 12 more authors.
Journal of Epidemiology | Year: 2013

Background: Using data from a large-scale community-based Japanese population, we attempted to identify factors associated with tooth loss in middle-aged and elderly men. Methods: A total of 8352 men aged 40 to 79 years who lived in the north of the main island of Japan and underwent health checkups were enrolled between 2002 and 2005. Number of teeth was assessed by the question, "How many teeth do you have (0, 1-9, 10-19, or ≥20)?". On the basis of the answer to this question, participants were classified into 2 groups (≤19 teeth or ≥20 teeth). Using multivariate logistic regression, factors related to having 19 or fewer teeth were estimated. Results: The numbers (percentages) of participants who had 0, 1 to 9, 10 to 19, and 20 or more teeth were 1764 (21.1%), 1779 (21.3%), 1836 (22.0%), and 2973 (35.6%), respectively. Among the participants overall and those aged 65 to 79 years, having 19 or fewer teeth was significantly associated with older age, smoking status (current smoking and ex-smoking), and low education level. In addition, men with 19 or fewer teeth were more likely to have a low body mass index and low serum albumin level and less likely to be current alcohol drinkers. Among men aged 40 to 64 years, but not men aged 65 to 79 years, those with 19 or fewer teeth were more likely to have a low serum high-density lipoprotein cholesterol level and high glycosylated hemoglobin (HbA1c) level. Conclusions: Smoking, low education level, and poor nutritional status were associated with tooth loss among middle-aged and elderly Japanese men. © 2013 Japan Epidemiological Association.


Tanno K.,Iwate Medical University | Ohsawa M.,Iwate Medical University | Onoda T.,Iwate Medical University | Itai K.,Iwate Medical University | And 11 more authors.
Journal of Psychosomatic Research | Year: 2012

Objective: Self-rated health (SRH) is associated with risk for mortality, but its biological basis is poorly understood. We examined the association between SRH and low-grade inflammation in a Japanese general population. Methods: A total of 5142 men and 11,114 women aged 40 to 69. years were enrolled. SRH was assessed by a single question and classified into four categories: good, rather good, neither good nor poor, and poor. Serum high-sensitivity C-reactive protein (hsCRP) levels were measured by the latex-enhanced immunonephelometric method. Elevated CRP was defined as hsCRP level of 1.0. mg/L or higher. The association between SRH and elevated CRP was evaluated by using logistic regression with adjustment for age, socioeconomic status (job status, education and marital status), health-related behaviors (smoking status, drinking status, exercise habits and sleep duration), and cardiovascular risk factors (body mass index, systolic blood pressure, total- and HDL-cholesterol, HbA1c and prevalent stroke and/or myocardial infarction). Results: Compared to persons with good SRH, persons with poor SRH had significantly higher risk for elevated CRP: age-adjusted ORs (95% CIs) were 1.33 (1.01-1.76) in men and 1.66 (1.36-2.02) in women. The significant association remained even after adjustment for socioeconomic status, health-related behaviors and cardiovascular risk factors in women, whereas the significance disappeared in men. Conclusion: Poor SRH is associated with low-grade inflammation in both sexes. In women, but not in men, the association is independent of potential confounders. These findings provide an insight into the biological background of SRH in a general population. © 2012 Elsevier Inc..


PubMed | The Research Institute of Strategy for Prevention, Iwate Health Service Association and Iwate Medical University
Type: Journal Article | Journal: BMC nephrology | Year: 2016

This study compared the combination of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) vs. eGFR and urine protein reagent strip testing to determine chronic kidney disease (CKD) prevalence, and each methods ability to predict the risk for cardiovascular events in the general Japanese population.Baseline data including eGFR, UACR, and urine dipstick tests were obtained from the general population (n=22 975). Dipstick test results (negative, trace, positive) were allocated to three levels of UACR (<30, 30-300, >300), respectively. In accordance with Kidney Disease Improving Global Outcomes CKD prognosis heat mapping, the cohort was classified into four risk grades (green: grade 1; yellow: grade 2; orange: grade 3, red: grade 4) based on baseline eGFR and UACR levels or dipstick tests.During the mean follow-up period of 5.6years, 708 new onset cardiovascular events were recorded. For CKD identified by eGFR and dipstick testing (dipstick testtrace and eGFR <60mL/min/1.73m(2)), the incidence of CKD was found to be 9% in the general population. In comparison to non-CKD (grade 1), although cardiovascular risk was significantly higher in risk grades 3 (relative risk (RR)=1.70; 95% CI: 1.28-2.26), risk predictive ability was not significant in risk grade 2 (RR=1.20; 95% CI: 0.95-1.52). When CKD was defined by eGFR and UACR (UACR 30mg/g Cr and eGFR <60mL/min/1.73m(2)), prevalence was found to be 29%. Predictive ability in risk grade 2 (RR=1.41; 95% CI: 1.19-1.66) and risk grade 3 (RR=1.76; 95% CI: 1.37-2.28) were both significantly greater than for non-CKD. Reclassification analysis showed a significant improvement in risk predictive abilities when CKD risk grading was based on UACR rather than on dipstick testing in this population (p<0.001).Although prevalence of CKD was higher when detected by UACR rather than urine dipstick testing, the predictive ability for cardiovascular events from UACR-based risk grading was superior to that of dipstick-based risk grading in the general population.


PubMed | University of Calgary, The Research Institute of Strategy for Prevention, Morioka University, Shiga University of Medical Science and 4 more.
Type: | Journal: International journal of cardiology | Year: 2015

The relative and absolute risks of outcomes other than all-cause death (ACD) attributable to atrial fibrillation (AF) stratified age have not been sufficiently investigated.A prospective study of 23,634 community dwellers aged 40 years or older without organic cardiovascular disease (AF=335, non-AF=23,299) was conducted. Multivariate-adjusted rates, rate ratios (RRs) and excess deaths (EDs) for ACD, cardiovascular death (CVD) and non-cardiovascular death (non-CVD), and sex- and age-adjusted RR and ED in middle-aged (40 to 69) and elderly (70 years or older) for ACD, CVD, non-CVD, sudden cardiac death (SCD), stroke-related death (Str-D), neoplasm-related death (NPD), and infection-related death (IFD) attributable to AF were estimated using Poisson regression.Multivariate-adjusted analysis revealed that AF significantly increased the risk of ACD (RR [95% confidence interval]:1.70 [1.23-2.95]) and CVD (3.86 [2.38-6.27]), but not non-CVD. Age-stratified analysis revealed that AF increased the risk of Str-D in middle-aged (14.5 [4.77-44.3]) and elderly individuals (4.92 [1.91-12.7]), SCD in elderly individuals (3.21 [1.37-7.51]), and might increase the risk of IFD in elderly individuals (2.02 [0.80-4.65], p=0.098). The RR of CVD was higher in middle-aged versus elderly individuals (RRs, 6.19 vs. 3.57) but the absolute risk difference was larger in elderly individuals (EDs: 7.6 vs. 3.0 per 1000 person-years).Larger absolute risk differences for ACD and CVD attributable to AF among elderly people indicate that the absolute burden of AF is higher in elderly versus middle-aged people despite the relatively small RR.

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