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ABSTRACT: Dietary behavior can worsen or prevent hypertension. However, data on the association between dietary behavior and the risk of hypertension in Asians are limited. The aim of this study was to determine these associations in Japanese male workers. We conducted a prospective study of 30-71-year-old Japanese male workers in Osaka, Japan, between 2001 and 2011. The study subjects were 3486 normotensive males who were assessed for an average of 4.6 years using an annual survey. We defined hypertension by a systolic blood pressure of 140 mm Hg, a diastolic blood pressure of 90 mm Hg and/or the use of antihypertensive medications. Dietary behavior questionnaires were included in the annual surveys. For each question on dietary behavior, we calculated the odds ratios (ORs) for the risk of hypertension using logistic regression models. We used subjects who consistently gave affirmative answers in the baseline and end-point surveys as a reference. The number of new cases of hypertension was 846 among 3486 subjects. Compared with subjects who eat meat frequently, subjects who did not eat meat frequently showed a higher risk of hypertension (OR=1.26, 95% confidence interval (CI): 1.00-1.59). Subjects who did not consume dairy products every day showed a higher risk of hypertension (OR=1.39, 95% CI: 1.13-1.71) compared with those who did. Meat and dairy product intake was associated with the prevention of hypertension among Japanese male workers.Hypertension Research advance online publication, 10 January 2013; doi:10.1038/hr.2012.205.
Hypertension Research 01/2013; · 2.58 Impact Factor
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Hironori Imano,
Hiroyasu Iso,
Masahiko Kiyama,
Kazumasa Yamagishi,
Tetsuya Ohira,
Shinichi Sato,
Hiroyuki Noda,
Kenji Maeda, Takeo Okada,
Takeshi Tanigawa,
Akihiko Kitamura
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ABSTRACT: OBJECTIVE: The objective was to determine whether non-fasting glucose concentration is a predictor for incident coronary heart disease. METHODS: We investigated a cohort data of 9,900 40- to 69-year-old residents in four Japanese communities for 1975-1986 baseline surveys of the Circulatory Risk in Communities Study (CIRCS). Non-fasting blood glucose concentrations were available for 7,332 participants. Diabetic type was defined as a glucose level of ≥11.1mmol/L and/or the use of medication for diabetes mellitus. RESULTS: A total of 170 coronary heart disease including 113 myocardial infarctions occurred in non-fasting participants within the median 22-year follow-up period. Multivariable hazard ratios (HRs) of incident coronary heart disease for the participants with diabetic type compared with the normal type were 1.98 (0.84-4.68) for men, 3.39 (1.47-7.81) for women, and 2.47 (1.37-4.46) for total subjects. Corresponding HRs for myocardial infarction were 2.14 (0.83-5.55), 5.70 (2.21-14.67) and 3.17 (1.65-6.10), respectively. Multivariable HRs of incident coronary heart disease per one standard deviation of serum glucose levels were 1.17 (1.02-1.36), 1.19 (1.03-1.38), and 1.19 (1.08-1.32), respectively. The corresponding HRs for myocardial infarction were 1.18 (1.00-1.38), 1.27 (1.07-1.49) and 1.23 (1.10-1.37). CONCLUSION: Non-fasting glucose concentration, either as diagnosis of diabetic type or as continuous variable, proved to be an independent predictor for incident coronary heart disease in middle-aged general population.
Preventive Medicine 09/2012; · 3.22 Impact Factor
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Yuji Shimizu,
Hironori Imano,
Tetsuya Ohira,
Akihiko Kitamura,
Masahiko Kiyama, Takeo Okada,
Yoshinori Ishikawa,
Takashi Shimamoto,
Kazumasa Yamagishi,
Takeshi Tanigawa,
Hiroyasu Iso
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ABSTRACT: Although serum alkaline phosphatase (ALP) levels have been associated with mortality from all-cause and from either ischemic or hemorrhagic stroke, no study has been published of the associations between ALP and the incidence of stroke. We therefore examined the associations of ALP with risk of stroke among Japanese, stratified by drinking status because ALP is known as an enzyme affected by alcohol consumption. We conducted a prospective cohort study of 10,754 Japanese subjects (4098 men and 6656 women) aged 40-69 years and living in 4 communities under systematic surveillance for stroke incidence. During the 16-year follow-up, we documented 264 strokes (164 ischemic strokes and 69 hemorrhagic strokes) for men and 225 strokes (118 ischemic strokes and 89 hemorrhagic strokes) for women. There was a U-shaped association between ALP level and stroke incidence in both men and women, which was confined primarily to nondrinkers. For nondrinkers, higher ALP levels were associated with an elevated risk of ischemic stroke for men and of hemorrhagic stroke for women, whereas lower ALP levels were associated with elevated risks of ischemic and hemorrhagic strokes in both men and women. Our data indicate that not only higher, but also lower, serum ALP level may be a predictor for the risk of stroke in nondrinking men and women.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 07/2012;
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Kazumasa Yamagishi,
Shinichi Sato,
Akihiko Kitamura,
Masahiko Kiyama, Takeo Okada,
Takeshi Tanigawa,
Tetsuya Ohira,
Hironori Imano,
Masahide Kondo,
Ichiro Okubo,
Yoshinori Ishikawa,
Takashi Shimamoto,
Hiroyasu Iso
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ABSTRACT: The nation-wide, community-based intensive hypertension detection and control program, as well as universal health insurance coverage, may well be contributing factors for helping Japan rank near the top among countries with the longest life expectancy. We sought to examine the cost-effectiveness of such a community-based intervention program, as no evidence has been available for this issue.
The hypertension detection and control program was initiated in 1963 in full intervention and minimal intervention communities in Akita, Japan. We performed comparative cost-effectiveness and budget-impact analyses for the period 1964-1987 of the costs of public health services and treatment of patients with hypertension and stroke on the one hand, and incidence of stroke on the other in the full intervention and minimal intervention communities.
The program provided in the full intervention community was found to be cost saving 13 years after the beginning of program in addition to the fact of effectiveness that; the prevalence and incidence of stroke were consistently lower in the full intervention community than in the minimal intervention community throughout the same period. The incremental cost was minus 28,358 yen per capita over 24 years.
The community-based intensive hypertension detection and control program was found to be both effective and cost saving. The national government's policy to support this program may have contributed in part to the substantial decline in stroke incidence and mortality, which was largely responsible for the increase in Japanese life expectancy.
Journal of hypertension 07/2012; 30(9):1874-9. · 4.02 Impact Factor
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Tetsuya Ohira,
Minako Maruyama,
Hironori Imano,
Akihiko Kitamura,
Masahiko Kiyama, Takeo Okada,
Kenji Maeda,
Kazumasa Yamagishi,
Hiroyuki Noda,
Renzhe Cui,
Sachiko Masuda,
Hiromichi Kimura,
Koji Tachikawa,
Yoshinori Ishikawa,
Hiroyasu Iso
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ABSTRACT: There is little evidence concerning risk factors for sudden cardiac death (SCD) among Asians.
A prospective, nested, case-control study of Japanese patients aged between 30 and 84 years was undertaken using data collected from 26 870 participants in cardiovascular risk surveys conducted in four communities between 1975 and 2005. The incidence of SCD was ascertained by systematic surveillance, with 239 cases of SCD identified over this period. For each case of SCD, three control patients were selected, matched by age, sex, examination year, follow-up time, and community.
Hypertension, diabetes mellitus, smoking, major ST-T abnormalities, left high amplitude R waves, and increased heart rate (≥77 beat/min) were all independently associated with a 1.5-3.2-fold increase in SCD risk, whereas no associations were observed for body mass index and hypercholesterolemia. The population-attributable fraction [95% confidence interval (CI)] was 23.0% (2.9-39.0) for hypertension, 15.3% (3.8-25.5) for current smoking, 14.5% (8.0-20.5) for major ST-T abnormalities, and 8.1% (2.2-13.7) for diabetes mellitus. The number of SCD risk factors (hypertension, diabetes, smoking, and ECG abnormalities) was positively associated with increased SCD risk. The odds ratio for increased SCD risk with three or more risk factors versus zero risk factors was 5.76 (95% CI 3.20-10.39).
Among the Japanese population, hypertension, smoking, major ST-T abnormalities, left high amplitude R waves, and diabetes mellitus were associated with an increased incidence of SCD, whereas there were no associations of body mass index or hypercholesterolemia with SCD incidence.
Journal of hypertension 06/2012; 30(6):1137-43. · 4.02 Impact Factor
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Mako Nagayoshi,
Takeshi Tanigawa,
Kazumasa Yamagishi,
Susumu Sakurai,
Akihiko Kitamura,
Masahiko Kiyama, Takeo Okada,
Kenji Maeda,
Tetsuya Ohira,
Hironori Imano,
Shinichi Sato,
Hiroyasu Iso
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ABSTRACT: Although associations between snoring and cardiovascular disease have been reported in several prospective studies, there is limited evidence from Asian populations. The objective of this study was to determine if there is an association between self-reported snoring frequency and the incidence of cardiovascular disease in Japanese.
The subjects were 2350 men and 4163 women aged 40 to 69 years who lived in 3 communities in Japan. All subjects were participants in the Circulatory Risk in Communities Study (CIRCS) and were followed for 6 years. Incidence of cardiovascular disease during the follow-up period comprised events of myocardial infarction, angina pectoris, sudden cardiac death and stroke.
During the 6-year follow-up period, 97 participants (56 men and 41 women) had cardiovascular events. After adjustment for potential confounding factors, self-reported snoring frequency was associated with an increased risk of cardiovascular events among women but not men. The hazard ratios (95% CI) for cardiovascular events were 0.9 (0.4-2.0) for sometimes snoring and 2.5 (1.0-6.1) for everyday snoring in women and 0.7 (0.3-1.3) and 1.0 (0.5-2.1), respectively, in men. Further adjustment for body mass index attenuated the association in women; the respective hazard ratios for cardiovascular events were 0.9 (0.4-1.9) and 2.1 (0.9-5.4).
Self-reported habitual snoring was associated with increased risk of cardiovascular events among Japanese women. Overweight may partly mediate this association.
Journal of Epidemiology 03/2012; 22(4):295-301. · 1.86 Impact Factor
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Minako Maruyama,
Tetsuya Ohira,
Hironori Imano,
Akihiko Kitamura,
Masahiko Kiyama, Takeo Okada,
Kenji Maeda,
Kazumasa Yamagishi,
Hiroyuki Noda,
Yoshinori Ishikawa,
Takashi Shimamoto,
Hiroyasu Iso
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ABSTRACT: There is little evidence whether sudden cardiac death (SCD) is increasing in Asia, although the incidence of coronary heart disease among urban middle-aged Japanese men has increased recently. We examined trends in the incidence of SCD and its risk factors in the Circulatory Risk in Communities Study.
This was a population-based longitudinal study. Surveillance of men and women for SCD incidence and risk factors was conducted from 1981 to 2005.
The surveyed population was all men and women aged 30-84 years who lived in three rural communities and one urban community in Japan.
Trends in SCD incidence and its risk factors.
Age-adjusted and sex-adjusted incidence of SCD decreased from 1981-1985 to 1991-1995, and plateaued thereafter. The annual incidence per 100 000 person-years was 76.0 in 1981-1985, 57.9 in 1986-1990, 39.3 in 1991-1995, 31.6 in 1996-2000 and 36.8 in 2001-2005. The prevalence of hypertension decreased from 1981-1985 to 1991-1995, and plateaued thereafter for men and women. The age-adjusted prevalence of current smoking for men decreased while that of diabetes mellitus increased for both sexes from 1981-1985 to 2001-2005.
The incidence of SCD decreased from 1981 to 1995 but was unchanged from 1996 to 2005. Continuous surveillance is necessary to clarify future trends in SCD in Japan because of an increasing incidence of diabetes mellitus.
BMJ open. 01/2012; 2(2):e000573.
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Yuji Shimizu,
Kenji Maeda,
Hironori Imano,
Tetsuya Ohira,
Akihiko Kitamura,
Masahiko Kiyama, Takeo Okada,
Yoshinori Ishikawa,
Takashi Shimamoto,
Kazumasa Yamagishi,
Takeshi Tanigawa,
Hiroyasu Iso
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ABSTRACT: Several epidemiological studies have established an association between chronic kidney disease (CKD), based on estimated glomerular filtration rate (GFR), and risk of stroke. However, sex-specific evidence for the relationship between CKD and risk of stroke and its subtypes is still limited.
We conducted a prospective cohort study of 12 222 Japanese men and women age 40 to 69 years living in 4 communities under systematic surveillance of stroke incidence to determine the relationship between CKD and risk of stroke and its subtypes.
During the 17-year follow-up, there were 566 strokes (327 ischemic and 186 hemorrhagic strokes). GFR was inversely associated with age- and community-adjusted risk of total stroke for both men and women. Compared with the reference group without CKD (GFR ≥60 mL/min per 1.73m(2)), the adjusted risks of total stroke for subjects with CKD (GFR <60 mL/min per 1.73m(2)) were 1.63 (1.22-2.17) for men and 1.51 (1.13-2.02) for women. Excess risk of stroke associated with CKD was identified primarily for hemorrhagic stroke among men and for ischemic stroke among women. After adjustment for traditional cardiovascular risk factors, associations remained statistically significant. When stratified by drinking status, excess risk of hemorrhagic stroke with CKD was confined to drinkers; adjusted risks were 4.18 (2.31-7.57) for men and 7.00 (1.92-25.56) for women.
CKD was associated with increased risk of hemorrhagic stroke for men, and of ischemic stroke for women. This sex difference may partly be explained by the difference in prevalence of drinkers between men and women.
Stroke 08/2011; 42(9):2531-7. · 5.73 Impact Factor
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ABSTRACT: The aim of this study was to identify the threshold level for non-high-density lipoprotein cholesterol (non-HDL-cholesterol) to raise the risk of coronary heart disease (CHD) incidence in a Japanese general population.
A total of 8,132 men and women, aged 40 to 69 years with no history of stroke or CHD, completed the baseline risk factor surveys between 1975 and 1987. Systematic surveillance of cardiovascular disease incidence was performed through 2003 (the median follow-up period was 21.9 years), and 155 incidents of CHD were identified.
We found a statistically significant association between non-HDL-cholesterol levels and the risk of CHD with a threshold around 140 mg/dL. After adjustment for potential confounding factors, this association did not change materially. The multivariable hazard ratio of CHD compared with that for levels of < 100 mg/dL was 2.49 (95% confidence interval: 1.35 to 4.61) for 140-159 mg/dL and 3.13 (1.58-6.21) for ≥ 180 mg/dL. Setting the cut-off point at ≥ 140 mg/dL non-HDL-cholesterol resulted in the greatest improvement of integrated discrimination.
Higher concentrations of non-HDL-cholesterol are associated with an increased risk of CHD with a threshold around 140 mg/dL, suggesting that the optimal cut-off point for healthy per-sons to prevent increasing the risk of CHD might be around 140 mg/dL non-HDL-cholesterol.
Journal of atherosclerosis and thrombosis 03/2011; 18(6):454-63. · 2.69 Impact Factor
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ABSTRACT: In Japan, there is growing concern that employees' health condition has been worsening under the severe labor conditions of the continuing recent deep recession. To determine trends in the prevalence of cardiovascular risk factors among employees, we analyzed 32 yr of systematic surveillance of urban Japanese employed men.
The surveyed population included male employees aged 40 to 59 yr who worked for four companies, a trading company, two banks and a company maintaining expressways in Osaka. Surveillance of cardiovascular risk factors was conducted from 1977 to 2008. We examined the annual mean values of systolic blood pressure, diastolic blood pressure, body mass index, and total serum cholesterol, and the prevalence of hypertension, obesity, hypercholesterolemia, smoking, alcohol drinkers, and high risk individuals who had two or more risk factors: (high blood pressure, high glucose and dyslipidemia).
The total number of employees aged 40-59 yr increased from 822 in 1977 to 2,651 in 1992, but then declined gradually to 1,455 in 2008. Among men aged 40-49 and 50-59, the prevalence of hypertension decreased from 25% and 39% in 1977 to 14% and 23% in 1992, respectively. However, the respective prevalence of hypertension started to rise thereafter to 29% and 47% in 2008, accompanied by an increase in blood pressure levels and the prevalence of antihypertensive medication use. Mean body mass index and the prevalence of obesity showed significant upward linear trends from the mid-1980's to 2008. Therefore, we speculate that the increase in blood pressure levels seen after the early 1990's associated with an increase in obesity. However the proportion of hypertension among non-overweight men also increased between the early 1990's and 2008, suggesting other factors are also involved in the increase of hypertension. The prevalence of hypercholesterolemia and high-risk individuals with obesity also increased in recent years. Mean total cholesterol level showed a linear increase from 195 mg/dl for men aged 40-49 and 196 mg/dl for men aged 50-59 in 1977 to 204 mg/dl and 207 mg/dl in 2008, respectively. The prevalence of high-risk individuals with obesity was 13% for men aged 40-49 and 15% for men aged 50-59 in 2008. Among men aged 50-59, the prevalence of non-overweight high-risk individuals became higher than that of high-risk individuals with obesity over time.
Although these findings were limited to the study companies, our data support evidence that Japanese employees have become increasingly at risk of cardiovascular diseases under the severe working conditions experienced since the 1990's. It is important to improve working conditions as well as personally control risk factors from the point of public health.
Sangyo eiseigaku zasshi Journal of occupational health 04/2010; 52(3):123-32.
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Yuji Shimizu,
Hironori Imano,
Tetsuya Ohira,
Akihiko Kitamura,
Masahiko Kiyama, Takeo Okada,
Shinichi Sato,
Takashi Shimamoto,
Kazumasa Yamagishi,
Takeshi Tanigawa,
Hiroyasu Iso
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ABSTRACT: Although serum gamma-glutamyltranspeptidase (GGT) levels have been associated with cardiovascular disease incidence, few studies have taken into account the effect of alcohol intake on GGT levels. In this study, we examined the relationship between GGT and stroke incidence according to drinking status.
We conducted a prospective cohort study of Japanese women (N=6281) and men (N=3471) aged 40 to 69 years living in communities under systematic surveillance for stroke incidence.
During the 18-year follow-up, 202 (3.2%) women and 230 (6.6%) men had strokes. Serum GGT levels were positively associated with risk of total stroke for women but not men. The multivariable hazard ratios of total stroke for the highest quartile of GGT compared with the lowest quartile were 1.56 (95% CI, 1.01 to 2.39) for women and 1.37 (95% CI, 0.89 to 2.11) for men. Moreover, GGT was associated with total and ischemic stroke risks for never-drinking women.
Serum GGT is associated with risk of total and ischemic strokes for Japanese women, especially never-drinkers.
Stroke 02/2010; 41(2):385-8. · 5.73 Impact Factor
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Akihiko Kitamura,
Shinichi Sato,
Masahiko Kiyama,
Hironori Imano,
Hiroyasu Iso, Takeo Okada,
Tetsuya Ohira,
Takeshi Tanigawa,
Kazumasa Yamagishi,
Masakazu Nakamura,
Masamitsu Konishi,
Takashi Shimamoto,
Minoru Iida,
Yoshio Komachi
Journal of the American College of Cardiology 08/2008; 52(1):71-9. · 14.16 Impact Factor
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Koutatsu Maruyama,
Shinichi Sato,
Tetsuya Ohira,
Kenji Maeda,
Hiroyuki Noda,
Yoshimi Kubota,
Setsuko Nishimura,
Akihiko Kitamura,
Masahiko Kiyama, Takeo Okada,
Hironori Imano,
Masakazu Nakamura,
Yoshinori Ishikawa,
Michinori Kurokawa,
Satoshi Sasaki,
Hiroyasu Iso
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ABSTRACT: To examine whether eating until full or eating quickly or combinations of these eating behaviours are associated with being overweight. Design and participants Cross sectional survey.
Two communities in Japan.
3287 adults (1122 men, 2165 women) aged 30-69 who participated in surveys on cardiovascular risk from 2003 to 2006.
Body mass index (overweight >/=25.0) and the dietary habits of eating until full (lifestyle questionnaire) and speed of eating (validated brief self administered questionnaire).
571 (50.9%) men and 1265 (58.4%) women self reported eating until full, and 523 (45.6%) men and 785 (36.3%) women self reported eating quickly. For both sexes the highest age adjusted mean values for height, weight, body mass index, and total energy intake were in the eating until full and eating quickly group compared with the not eating until full and not eating quickly group. The multivariable adjusted odds ratio of being overweight for eating until full was 2.00 (95% confidence interval 1.53 to 2.62) for men and 1.92 (1.53 to 2.40) for women and for eating quickly was 1.84 (1.42 to 2.38) for men and 2.09 (1.69 to 2.59) for women. The multivariable odds ratio of being overweight with both eating behaviours compared with neither was 3.13 (2.20 to 4.45) for men and 3.21 (2.41 to 4.29) for women.
Eating until full and eating quickly are associated with being overweight in Japanese men and women, and these eating behaviours combined may have a substantial impact on being overweight.
BMJ (Clinical research ed.). 01/2008; 337:a2002.
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Tetsuya Ohira,
Chikako Nakamura,
Hironori Imano, Takeo Okada,
Akihiko Kitamura,
Masahiko Kiyama,
Yuko Nakagawa,
Shinichi Sato,
Masakazu Nakamura,
Yoshihiko Naito,
Michinori Kurokawa,
Yumiko Nakashita,
Masayo Yamamoto,
Kazuyo Kamei,
Yuko Horii,
Takashi Shimamoto
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ABSTRACT: We sought to examine relationships of lifestyle factors, including diet, physical activity, sleep, alcohol consumption and smoking, with perceived stress and depressive symptoms.
Between 2001 and 2002, 7,947 men and women (mean 52.4 years) took part in examinations at the Osaka Medical Center for Health Science and Promotion. Lifestyle factors were determined by structured interview or by self-administered questionnaire. Associations of life style factors with perceived stress and depressive symptoms were tested by stepwise logistic regression analyses.
Higher proportions of persons with depressive symptoms tended to be associated with higher proportions of persons with perceived stress. Among both men and women, low physical activity, lack of regular physical exercise, short sleeping time, to skip breakfast frequently, and having dinner within a couple of hours before going to bed were associated with both perceived stress and depressive symptoms. Men reporting between-meal or midnight snacks and having eating until they were full had higher odds ratios for perceived stress, while men conducting regular physical exercise and consuming 3 or more dishes of vegetables per day had lower odds ratios for depressive symptoms. For women, high odds ratios for depressive symptoms and perceived stress were observed among those who tended to have salty foods (or frequent use of soy sauce) and a lower odds ratio for perceived stress was noted among persons who had soy products every day.
Lifestyle facets such as skipping breakfast, low physical activity, and short sleeping time, appear to be associated with psychological health status of Japanese men and women.
[Nippon kōshū eisei zasshi] Japanese journal of public health 05/2007; 54(4):226-35.
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Shinichi Sato,
Hiroyasu Iso,
Hiroyuki Noda,
Akihiko Kitamura,
Hironori Imano,
Masahiko Kiyama,
Tetsuya Ohira, Takeo Okada,
Masayuki Yao,
Takeshi Tanigawa,
Kazumasa Yamagishi,
Masakazu Nakamura,
Yoshihiko Naito,
Takashi Shimamoto
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ABSTRACT: We aimed to examine the impact of fibrinogen concentrations on the incidence of stroke.
We examined the association between fibrinogen and risk of total stroke and stroke subtypes in an 11-year prospective study of 4608 men and 7589 women aged 40 to 79 years with no history of stroke and/or coronary heart disease. The analysis was repeated, stratified by smoking status, to examine whether the association between fibrinogen and stroke was modified by smoking.
There were 317 incident total strokes comprising 103 hemorrhagic strokes (70 intraparenchymal hemorrhages [22.1% of strokes], 33 subarachnoid hemorrhages [10.4%]), 206 ischemic strokes (65.0%), and 8 strokes of undetermined type (2.5%). The multivariable hazard ratio (95% CI) for the highest versus lowest fibrinogen quartiles after adjustment for age, sex, area, and known cardiovascular risk factors was 2.5 (1.3 to 5.0), P<0.01, for hemorrhagic stroke and 3.2 (1.4 to 7.4), P<0.01, for intraparenchymal hemorrhage. There was no positive association of fibrinogen with risk of ischemic stroke or subarachnoid hemorrhage. Among never-smokers, the multivariable hazard ratio (95% CI) for the highest versus lowest fibrinogen quartiles was 3.5 (1.3 to 9.3), P=0.01, for hemorrhagic stroke and 4.4 (1.3 to 15.2), P=0.02, for intraparenchymal hemorrhage.
High plasma fibrinogen concentration can be a predictor for risk of intraparenchymal hemorrhage.
Stroke 10/2006; 37(10):2488-92. · 5.73 Impact Factor
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Akihiko Kitamura,
Yuko Nakagawa,
Minoru Sato,
Hiroyasu Iso,
Shinichi Sato,
Hironori Imano,
Masahiko Kiyama, Takeo Okada,
Hiroshi Okada,
Minoru Iida,
Takashi Shimamoto
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ABSTRACT: Higher proportions of hemorrhagic stroke and lacunar infarction were reported in rural Japan compared with those in Western countries. We examined the relative proportions of stroke subtypes in an urban Japanese city where westernized lifestyles are more common than in rural areas.
Stroke registration was performed in 1992, 1997, and 2002 for residents > or =40 years of age who were admitted with acute strokes to all of the 10 hospitals with > or =90 beds in Yao City, Osaka, Japan. Strokes were classified as intraparenchymal hemorrhage, subarachnoid hemorrhage, or ischemic strokes (embolic infarction, large-artery occlusive infarction, lacunar infarction, and unclassified thrombotic infarction) by criteria using computed tomography or MRI.
A total of 650 first-ever strokes were registered. The age-adjusted proportion of each stroke subtype was not significantly different among the 3 study periods in both men and women. Throughout the 3 periods, intraparenchymal hemorrhage, subarachnoid hemorrhage, and ischemic stroke accounted for 26%, 7%, and 65% in men, respectively. In women, the respective proportions were 29%, 21%, and 44%. The proportion of each subtype for total ischemic strokes was as follows: 51% to 61% lacunar infarction, 25% to 26% large-artery occlusive infarction, and 11% to 17% embolic infarction.
Our study showed that hemorrhagic stroke represented a large proportion of all strokes, especially among women, and lacunar infarction was the most common subtype of ischemic stroke among both men and women in Yao City, which differed from findings in Western countries.
Stroke 07/2006; 37(6):1374-8. · 5.73 Impact Factor
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ABSTRACT: The development of an efficient noninvasive examination to detect coronary atherosclerosis is needed as a strategy to prevent coronary heart disease. To evaluate the usefulness of calcium score measured by multi-detector row computed tomography (MDCT), we compared calcium score derived from MDCT with findings of coronary artery stenosis assessed by coronary angiography (CAG).
In 108 patients (94 men, 14 women; average age, 65.7 years), we performed unenhanced CT scans and calculated coronary artery calcium score in 259 vessels without previous intervention and severe motion artifact to determine the correlation with the degree of coronary stenosis by CAG.
The sensitivity and the specificity of calcification (calcium score 0.1+) for severe stenosis (75+%) were 89% and 43%, respectively. All four vessels with calcium score 1000+ had a severe stenosis. The areas under the receiver operating characteristics curve of calcium score for severe stenosis were 0.80 +/- 0.04, indicating the efficacy of this technique.
Coronary artery calcification and calcium score determined by MDCT were associated with coronary arteries with severe stenosis. This technique appears to be useful for the evaluation of coronary atherosclerosis.
Journal of Epidemiology 10/2005; 15(5):187-93. · 1.86 Impact Factor
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ABSTRACT: Few cohort studies have examined the association of carotid intima-media thickness (IMT) and plaque characteristics with the risk of stroke in apparently healthy persons. We examined the relationship of carotid IMT and the surface, morphology, and calcification of carotid plaques with the incidence of stroke among Japanese men.
Carotid IMT and plaque were evaluated bilaterally with ultrasonography in 1289 men aged 60 to 74 years without a previous stroke or coronary heart disease. In this cohort, the subsequent incidence of stroke was investigated.
During the 4.5-year follow-up, 34 strokes occurred. The multivariate-adjusted relative risk (95% CI) for the highest versus lowest quartiles of maximum IMT of the common carotid artery (CCA; > or =1.07 versus < or =0.77 mm) was 3.0 (1.1 to 8.3) for stroke. The combination of CCA and internal carotid artery (ICA) wall thickness was a better predictor of the risk of stroke than was CCA wall thickness alone. Men with a plaque, defined as a focal wall thickness of > or =1.5 mm, in the ICA had a 3-fold higher risk of stroke than those without a plaque, and the plaque surface irregularity further increased the stroke risk. A significant excess risk of stroke was confined to men with an uncalcified plaque.
Increased IMT of the CCA and an uncalcified plaque in the ICA, as assessed by ultrasonography, are risk factors for stroke in elderly Japanese men.
Stroke 12/2004; 35(12):2788-94. · 5.73 Impact Factor
