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Sleep-related breathing disorder (SRBD) causes hypertension, and obesity has been highly associated with SRBD, which has become a serious health problem in young and middle-aged Japanese males. However, the relation between SRBD and hypertension considering the effects of obesity remains unknown. In this cross-sectional study, we examined the relationship between SRBD and hypertension, with consideration for the effects of obesity, in Japanese occupational population. Using 3% oxygen desaturation index (3%ODI) obtained by simplified polysomnography (PSG), participants were classified into low (0 ≤ 3%ODI < 5), medium (5 ≤ 3%ODI < 15), and high (15 ≤ 3%ODI) 3%ODI groups. We excluded employees who had not undergone medical examination with simplified PSG in the same year from 2012 to 2018. Logistic regression analysis was performed to calculate odds ratios for having hypertension according to 3%ODI levels. In total, 2532 employees were included. Among them, 25% and 4% were categorized into the medium and high 3%ODI groups, respectively. The odds ratio for hypertension increased significantly with higher 3%ODI levels after adjustment for age, sex, alcohol drinking status and smoking status (p for trend < 0.0001). However, further adjustment for obesity status (body mass index ≥ 25 kg/m2) attenuated the associations. When we performed the stratified analysis by obesity status, the odds ratio for hypertension increased significantly with higher 3%ODI only for non-obese individuals, with significant interaction (p for interaction = 0.014). Higher 3%ODI was significantly associated with higher prevalence of hypertension especially in non-obese participants, suggesting the importance of vigilance for the presence of SRBD even in non-obese individuals. We investigated the association between SRBD and hypertension considering the effects of obesity, which would suggest the need to keep in mind the presence of SRBD even in non-obese individuals.

DOI： 10.1038/s41440-024-01612-y

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Language：English   Publisher：(一社)日本疫学会  

＜Highlight＞●本研究は、血清リポ多糖結合蛋白(LBP)値とメタボリックシンドローム(MetS)発症との関連を検討した最初の前向きコホート研究である。●血清LBP値の上昇に伴いメタボリックシンドロームおよびその構成要素の発症リスクは上昇した。●媒介解析において、HOMA-IRと血清高感度CRPは血清LBPとMetS発症との関連に、部分的に介在していた。●血清LBP値とメタボリックシンドロームの発症リスクの関連はインスリン抵抗性と慢性炎症を介した機序が示唆された。(著者抄録)

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UNLABELLED: Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that commonly originates from the right or noncoronary sinuses and rarely from the left sinus. SVA is usually diagnosed in the setting of clinical sequelae of a rupture. We herein report a case of an unruptured left SVA presenting as acute myocardial infarction. A 54-year-old woman with a history of radical operation for patent ductus arteriosus in childhood was transferred to our hospital. An electrocardiogram indicated extensive myocardial ischemia with ST elevation. Urgent coronary angiography was performed but was unable to identify the left coronary artery. Subsequent aortography and computed tomography revealed a large SVA originating from the left sinus and compressing the left coronary artery. The patient died after approximately one month of intensive care, including mechanical circulatory support and coronary artery bypass grafting. Autopsy confirmed that the left main coronary trunk was stretched and compressed by the SVA and revealed unexpected atherosclerosis in the left anterior descending artery. Although a left SVA is an extremely rare anomaly, it occasionally provokes fatal myocardial infarction. Since an SVA might hinder performing percutaneous coronary intervention, cardiac surgery should be considered when myocardial ischemia is recognized. LEARNING OBJECTIVE: We herein report a case of an unruptured left sinus of Valsalva aneurysm (SVA) with acute myocardial infarction. Urgent percutaneous coronary intervention (PCI) was unsuccessful, as the left coronary artery was compressed by the SVA. The patient died after intensive care, including coronary artery bypass grafting (CABG). SVA, especially from the left sinus, is extremely rare but occasionally provokes myocardial infarction by compressing the coronary arteries. Because SVA might hinder PCI, CABG should be considered when myocardial ischemia is recognized.

DOI： 10.1016/j.jccase.2023.10.003

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AIMS: Several prospective studies have reported that higher visit-to-visit blood pressure variability (BPV) is associated with atrial fibrillation (AF). However, no studies have investigated the association between day-to-day BPV assessed by home blood pressure measurement and the development of AF. METHODS: A total of 2,827 community-dwelling Japanese aged ≥40 years without prior AF were followed up for 10 years (2007-2017). Day-to-day home BPV (defined as coefficients of variation [CoV] of home systolic blood pressure [SBP] for 28 days) were categorized into 4 groups according to the quartiles: Q1, ≤4.64%; Q2, 4.65%-5.70%; Q3, 5.71%-7.01%; Q4, ≥7.02%. The hazard ratios for developing AF were estimated using a Cox proportional hazards model. RESULTS: During the follow-up period, 134 participants developed new-onset AF. The crude incidence rates of AF increased significantly with higher CoV levels of home SBP: 2.1, 4.7, 5.3, and 8.8 per 1000 person-years in the first, second, third, and fourth quartiles, respectively (P for trend <0.01). After adjusting for potential confounders, increased CoV levels of home SBP were associated significantly with a higher risk of AF (P for trend =0.02). The participants in the highest quartile of CoV had a 2.18-fold (95% confidence intervals: 1.18-4.04) increased risk of developing AF compared to those in the lowest quartile. CONCLUSIONS: The present findings suggest that increased day-to-day home BPV levels are associated with a higher risk of the development of AF in a general Japanese population.

DOI： 10.1093/eurjpc/zwae035

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Language：English   Publisher：(一社)日本心臓病学会  

症例は54歳女性で、突然の胸痛のため救急医療部へ搬送された。動脈管開存症の既往があった。搬送時の血圧は73/50mmHg、心拍数は122bpmであった。心電図は洞性頻脈で左軸偏位を認め、I、aVR、aVL、V3～V6誘導でST上昇、II、III、aVF誘導でST低下を認めた。胸部X線検査で肺水腫を認めた。臨床検査で心筋トロポニンTは0.159ng/mL、クレアチニンキナーゼ(CK)-MBは36.7U/Lであった。緊急冠動脈造影で左冠動脈は描出されなかった。大動脈造影を施行した。その結果、左冠動脈洞が瘤化しており、瘤径は5cmであった。右および無冠動脈洞に異常はなかった。左バルサルバ洞動脈瘤と診断し、大動脈内バルーンパンピングと体外式膜型人工肺(VA-ECMO)を導入した。CT血管造影で左冠動脈主幹部は左冠動脈洞瘤により圧排されていた。3日後に完全房室ブロックが出現し、心原性ショックに陥った。心拍動下冠動脈バイパス術を施行した。5日後にImpella CPの併用を開始したが、左室壁運動は回復せず、26日後に出血性脳梗塞のため死亡した。剖検で左回旋枝にアテロームプラークによる狭窄病変が検出された。

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BACKGROUND: Five modifiable risk factors are associated with cardiovascular disease and death from any cause. Studies using individual-level data to evaluate the regional and sex-specific prevalence of the risk factors and their effect on these outcomes are lacking. METHODS: We pooled and harmonized individual-level data from 112 cohort studies conducted in 34 countries and 8 geographic regions participating in the Global Cardiovascular Risk Consortium. We examined associations between the risk factors (body-mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, current smoking, and diabetes) and incident cardiovascular disease and death from any cause using Cox regression analyses, stratified according to geographic region, age, and sex. Population-attributable fractions were estimated for the 10-year incidence of cardiovascular disease and 10-year all-cause mortality. RESULTS: Among 1,518,028 participants (54.1% of whom were women) with a median age of 54.4 years, regional variations in the prevalence of the five modifiable risk factors were noted. Incident cardiovascular disease occurred in 80,596 participants during a median follow-up of 7.3 years (maximum, 47.3), and 177,369 participants died during a median follow-up of 8.7 years (maximum, 47.6). For all five risk factors combined, the aggregate global population-attributable fraction of the 10-year incidence of cardiovascular disease was 57.2% (95% confidence interval [CI], 52.4 to 62.1) among women and 52.6% (95% CI, 49.0 to 56.1) among men, and the corresponding values for 10-year all-cause mortality were 22.2% (95% CI, 16.8 to 27.5) and 19.1% (95% CI, 14.6 to 23.6). CONCLUSIONS: Harmonized individual-level data from a global cohort showed that 57.2% and 52.6% of cases of incident cardiovascular disease among women and men, respectively, and 22.2% and 19.1% of deaths from any cause among women and men, respectively, may be attributable to five modifiable risk factors. (Funded by the German Center for Cardiovascular Research (DZHK); ClinicalTrials.gov number, NCT05466825.).

DOI： 10.1056/NEJMoa2206916

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DOI： 10.5551/jat.ER61960

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Language：English   Publisher：Journal of Dental Research  

Ectopic enrichment of oral microbes in the gut is a notable alteration in gut microbial balance. These microbes are likely delivered from the oral cavity with saliva and food; however, evidence of oral–gut microbial transmission is insufficient and needs further investigation. In this observational study, we examined 144 pairs of saliva and stool samples collected from community-dwelling adults to verify the oral–gut microbial link and identify the relevant influencing factors on the increased abundance of oral microbes within the gut. The bacterial composition of each sample was determined using PacBio single-molecule long-read sequencing of the full-length 16S ribosomal RNA gene and amplicon sequence variant (ASV) analysis. Although the bacterial compositions of salivary and gut microbiota were distinctly different, at least 1 ASV was shared between salivary and gut microbiota in 72.9% of subjects. Shared ASVs accounted for 0.0% to 63.1% (median 0.14%) of the gut microbiota in each subject and frequently included abundant Streptococcus salivarius and Streptococcus parasanguinis. Their total relative abundance in the gut was significantly higher in older subjects or those with dental plaque accumulation. The gut microbiota with ≥5% of shared ASVs displayed a higher abundance of Streptococcus, Lactobacillus, and Klebsiella and a lower abundance of Faecalibacterium, Blautia, Megamonas, and Parabacteroides. Our study presents evidence for the translocation of oral bacteria to the gut in community-dwelling adults and suggests that aging and dental plaque accumulation contribute to an increased abundance of oral microbes in the gut, which might be relevant to the compositional shift in the gut commensals.

DOI： 10.1177/00220345231160747

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CONTEXT: Serum Mac-2 binding protein glycosylation isomer (M2BPGi) concentrations are known to be an indicator of chronic liver injury and fibrosis. OBJECTIVE: This study aimed to investigate the association between serum M2BPGi concentrations and the development of type 2 diabetes in a Japanese community. METHODS: A total of 2143 community-dwelling Japanese individuals aged 40-79 years without diabetes at baseline were followed up for 7 years. Serum M2BPGi concentrations were divided into quintiles: Q1, ≤0.37 cutoff index (COI); Q2, 0.38-0.49 COI; Q3, 0.50-0.62 COI; Q4, 0.62-0.80 COI; and Q5, ≥0.81 COI. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs for the development of type 2 diabetes. RESULTS: During the follow-up period, 219 individuals developed type 2 diabetes. The age- and sex-adjusted cumulative incidence of type 2 diabetes significantly increased with elevating serum M2BPGi levels (P for trend < .01). This association remained significant after adjustment for potential confounders (P for trend = .04). This significant association attenuated to a nonsignificant level after additionally adjusting for serum high-sensitivity C-reactive protein or homeostasis model assessment of insulin resistance. CONCLUSION: The present study demonstrated that higher serum M2BPGi concentrations were significantly associated with higher risk of diabetes in a Japanese community. Moreover, inflammation and insulin resistance were suggested to contribute to the excess risk of diabetes in individuals with higher serum M2BPGi levels. These findings shed light on the importance of inflammation and insulin resistance when considering the pathogenesis of diabetes.

DOI： 10.1210/clinem/dgad011

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Language：English   Publisher：(一社)日本動脈硬化学会  

日本の集団ベース研究である久山町研究のデータを用いて、集団レベルでの血清エイコサペンタエン酸(EPA)/アラキドン酸(AA)比、血清EPA濃度、血清AA濃度の10年間の変化を評価した。2002～2003年と2012～2013年に久山町研究に参加した40歳以上でEPA薬を服用していない地域住民(2002～2003年は3194名、2012～2013年は3220名)のデータを解析した。血清EPA/AA比は10年間で低下し、2002年と2012年の幾何平均値はそれぞれ0.40、0.32であった。血清EPA濃度は軽度に上昇し、2002年と2012年の幾何平均値はそれぞれ59.0μg/mL、65.1μg/mLであった。血清AA濃度は大きく上昇し、2002年と2012年の幾何平均値はそれぞれ147.6μg/mL、199.9μg/mLであった。年齢群別の解析では、血清EPA/AA比は80歳以上を除いて有意に低下し、若年群ほど低下が大きかった。血清EPA濃度は50～59歳で有意に低下し、70歳以上で有意に上昇した。血清AA濃度はすべての年齢群で有意に上昇した。

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RATIONALE & OBJECTIVE: Chronic kidney disease, defined by albuminuria and/or reduced estimated glomerular filtration rate (eGFR), has been reported to be associated with brain atrophy and/or higher white matter lesion volume (WMLV), but there are few large-scale population-based studies assessing this issue. This study aimed to examine the associations between the urinary albumin-creatinine ratio (UACR) and eGFR levels and brain atrophy and WMLV in a large-scale community-dwelling older population of Japanese. STUDY DESIGN: Population-based cross-sectional study. SETTING & PARTICIPANTS: A total of 8,630 dementia-free community-dwelling Japanese aged greater than or equal to 65 years underwent brain magnetic resonance imaging scanning and screening examination of health status in 2016-2018. EXPOSURES: UACR and eGFR levels. OUTCOMES: The total brain volume (TBV)-to-intracranial volume (ICV) ratio (TBV/ICV), the regional brain volume-to-TBV ratio, and the WMLV-to-ICV ratio (WMLV/ICV). ANALYTICAL APPROACH: The associations of UACR and eGFR levels with the TBV/ICV, the regional brain volume-to-TBV ratio, and the WMLV/ICV were assessed by using an analysis of covariance. RESULTS: Higher UACR levels were significantly associated with lower TBV/ICV and higher geometric mean values of the WMLV/ICV (P for trend = 0.009 and <0.001, respectively). Lower eGFR levels were significantly associated with lower TBV/ICV, but not clearly associated with WMLV/ICV. In addition, higher UACR levels, but not lower eGFR, were significantly associated with lower temporal cortex volume-to-TBV ratio and lower hippocampal volume-to-TBV ratio. LIMITATIONS: Cross-sectional study, misclassification of UACR or eGFR levels, generalizability to other ethnicities and younger populations, and residual confounding factors. CONCLUSIONS: The present study demonstrated that higher UACR was associated with brain atrophy, especially in the temporal cortex and hippocampus, and with increased WMLV. These findings suggest that chronic kidney disease is involved in the progression of morphologic brain changes associated with cognitive impairment.

DOI： 10.1016/j.xkme.2022.100593

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Language：Others   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

Several prospective Western studies have reported an inverse association of vegetable and fruit intake with dementia risk. However, there is limited epidemiologic evidence in Asians. This study investigated the association of intakes of vegetables, fruits, and their nutrients on the risk of incident dementia and its subtypes in a Japanese community.

Methods

A total of 1071 participants (452 men and 619 women) aged ≥60 years without dementia at baseline were prospectively followed up for 24 years. Intakes of vegetables, fruits, and nutrients were evaluated using a 70-item semiquantitative food frequency questionnaire at baseline and were categorized into quartiles separately by gender. The outcome measure was the development of dementia and its subtypes—namely, Alzheimer’s disease (AD) and vascular dementia (VaD). The risk estimates of incident dementia were computed using a Cox proportional hazards model.

Results

During the long-term follow-up period, 464 subjects developed dementia, of whom 286 had AD and 144 had VaD. Higher vegetable intake was associated gradually with lower risk of developing dementia and AD (both P-trend &lt; 0.05), but not VaD, after adjusting for confounders. Subjects allocated the highest quartile of vegetable intake had 27 and 31% lower risk of dementia and AD, respectively, than those with the lowest quartile. The risk of dementia decreased significantly with higher intakes of vitamin A, riboflavin, vitamin C, magnesium, calcium, and potassium (all P-trend &lt; 0.05). Subjects with higher total dietary fiber intake tended to be at decreased risk for total dementia (P-trend = 0.07). Meanwhile, there were no significant associations between fruit intake and the risk of dementia and its subtypes.

Conclusion

Higher intakes of vegetables and their constituent nutrients were associated with a lower risk of dementia in Japanese older adults. A diet rich in vegetables may be beneficial in reducing the dementia risk in Asians.

DOI： 10.1186/s12877-022-02939-2

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Other Link： https://link.springer.com/article/10.1186/s12877-022-02939-2/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Epidemiological Association  

<p><b>Background:</b> The association between chronic lipopolysaccharide exposure and the development of metabolic syndrome (MetS) is unclear. In this study we examined the association between serum lipopolysaccharide-binding protein (LBP) levels, an indicator of lipopolysaccharide exposure, and the development of MetS in a general Japanese population.</p><p><b>Methods:</b> 1,869 community-dwelling Japanese individuals aged ≥40 years without MetS at baseline examination in 2002–2003 were followed up by repeated examination in 2007–2008. MetS was defined according to the Japanese criteria. Serum LBP levels were classified into quartiles (quartiles 1–4: 2.20–9.56, 9.57–10.78, 10.79–12.18, and 12.19–24.34 µg/mL, respectively). Odds ratios (ORs) for developing MetS were calculated using a logistic regression model.</p><p><b>Results:</b> At the follow-up survey, 159 participants had developed MetS. Higher serum LBP levels were associated with greater risk of developing MetS after multivariable adjustment for age, sex, smoking, drinking, and exercise habits (OR [95% confidence interval] for quartiles 1–4: 1.00 [reference], 2.92 [1.59–5.37], 3.48 [1.91–6.35], and 3.86 [2.12–7.03], respectively; <i>P</i> for trend <0.001). After additional adjustment for homeostasis model assessment of insulin resistance, this association was attenuated but remained significant (<i>P</i> for trend = 0.007). On the other hand, no significant association was observed after additional adjustment for serum high-sensitivity C-reactive protein (<i>P</i> for trend = 0.07).</p><p><b>Conclusion:</b> In the general Japanese population, our findings suggest that higher serum LBP levels are associated with elevated risk of developing MetS. Low-grade endotoxemia could play a role in the development of MetS through systemic chronic inflammation and insulin resistance.</p>

DOI： 10.2188/jea.JE20220232

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Language：English   Publisher：(一社)日本動脈硬化学会  

一般日本人集団の前向き追跡データを用いて、再発性脳卒中の5年リスクにみられる傾向を半世紀にわたり検討した。福岡県久山町の住民を対象に、1961年から続けられている久山町研究のデータを利用した。1961年(154名)、1974年(144名)、1988年(172名)、2002年(146名)を起点とする四つのコホートを設定し、脳卒中発症患者を起点から10年間追跡したデータを用いて再発性脳卒中リスクを調査した。全種類の脳卒中および虚血性脳卒中を発症した後の再発性脳卒中リスクは、一番目(1961年)のコホートから三番目のコホートにかけて有意に低下していたが、三番目から四番目のコホートでは明瞭な変化は示されなかった。出血性脳卒中後の同リスクは主として一番目から二番目のコホートにかけて低下しており、二番目から四番目まででは明らかな低下はみられなかった。こうした傾向は年齢・性別で調整しても実質的に不変であった。

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Background Several longitudinal studies have reported that higher visit-to-visit blood pressure variability is associated with greater risk for developing chronic kidney disease. However, no population-based studies have investigated the association between day-to-day home blood pressure variability and incident chronic kidney disease. Methods and Results A total of 2342 Japanese community-dwelling residents aged ≥40 years without chronic kidney disease at baseline were followed up by annual health examinations for 10 years. Home blood pressure was measured 3 times every morning for 28 days. Day-to-day coefficients of variation of home systolic blood pressure levels were categorized into quintiles. Chronic kidney disease was defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m2 or the presence of proteinuria. The hazard ratios for developing chronic kidney disease were estimated with a Cox proportional hazards model. During the follow-up period, 772 participants developed chronic kidney disease. Increased coefficients of variation of home systolic blood pressure were associated significantly with higher risk of chronic kidney disease after adjusting for confounders (P for trend <0.001): Individuals in the highest quintile of coefficients of variation had a 1.50-fold (95% CI, 1.17-1.94) greater risk of developing chronic kidney disease than those in the lowest quintile. The combination of higher coefficients of variation and higher mean value of home systolic blood pressure was associated with the multivariable-adjusted risk of developing chronic kidney disease. Conclusions These findings suggest that increased day-to-day blood pressure variability is a significant risk factor for developing chronic kidney disease in a general Japanese population.

DOI： 10.1161/JAHA.122.027173

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Atherosclerosis Society  

<p> <b>Aim:</b> Circulating omega-3 and omega-6 polyunsaturated fatty acids may to contribute to cardiovascular health at the population level. Over a decade, we investigated changes in the serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio, and in serum concentrations of the individual fatty acids, in a Japanese community.</p><p> <b>Methods:</b> Community surveys took place in 2002–2003 and 2012–2013 in a rural area of Japan. The community surveys included 3,194 and 3,220 community dwellers aged ≥ 40 years who did not take EPA medication in 2002–2003 and 2012–2013, respectively. Fatty acid fractionations in serum were measured using a gas chromatography method. Changes in the serum EPA/AA ratio over time were examined using linear mixed models.</p><p><b>Results:</b> Overall, the average serum EPA/AA ratio decreased over the 10 years. A decreasing trend in the serum EPA/AA ratio occurred in all age groups except participants aged ≥ 80 years, with larger decreases in the younger age groups. A similar decline in serum EPA/AA ratio occurred in participants with and those without lipid-lowering therapy. Serum EPA concentrations were slightly increased in the whole population but remained stable or even decreased in participants aged 40–69. In contrast, the average serum AA concentrations increased in all age groups.</p><p><b>Conclusion:</b> In a Japanese community, the serum EPA/AA ratio decreased over 10 years at the population level, especially in middle-aged participants.</p>

DOI： 10.5551/jat.63727

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AIMS/INTRODUCTION: We aimed to investigate the association of active commuting (cycling or walking to work), as well as the association of the individual commuting modes, with the risk of diabetes in a prospective cohort of community-dwelling adults in Japan. MATERIAL AND METHODS: A total of 1,270 residents aged 40-79 years were followed up for a median of 14 years. Active commuting was defined as either cycling or walking to work. A Cox proportional hazards model was used to examine the association of active commuting with the risk of diabetes. Associations for different forms of active commuting (cycling, walking and mixed modes of cycling or walking with non-active components) were also examined. RESULTS: During the follow-up period, 191 participants developed diabetes. Active commuting was associated with a lower risk of diabetes than non-active commuting after adjustment for potential confounders (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.31-0.92). With regard to the commuting modes, the risk of diabetes was significantly lower in individuals who commuted by cycling alone (HR 0.46, 95% CI 0.22-0.98), and tended to be lower in individuals who commuted by walking alone (HR 0.14, 95% CI 0.02-1.02) compared with that in individuals with non-active commuting. Meanwhile, no significant associations were observed for the mixed mode of walking and non-active commuting (HR 1.69, 95% CI 0.77-3.71). CONCLUSIONS: Active commuting, particularly that consisting exclusively of cycling or walking, was associated with a reduced risk of diabetes. Our findings support a public health policy that promotes the choice of active commuting for the prevention of diabetes.

DOI： 10.1111/jdi.13844

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RATIONALE: Several Western studies have reported that participants with preserved ratio impaired spirometry (PRISm) have higher risks of airflow limitation (AFL) and death. However, evidence in East Asian populations is limited. OBJECTIVES: To investigate the relation between PRISm and the risks of death and incident AFL in a Japanese population. METHODS: A total of 3,032 community-dwelling Japanese participants aged ≥40 years were followed up for a median of 5.3 years by annual spirometry examinations. Participants were classified into lung function categories at baseline as follows: normal spirometry (forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ≥0.70 and FEV1 ≥80% predicted), PRISm (≥0.70 and <80%), AFL Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 (<0.70 and ≥80%), and AFL GOLD 2-4 (<0.70 and <80%). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were computed using a Cox proportional hazard model. MEASUREMENTS AND MAIN RESULTS: During the follow-up period, 131 participants died, 22 of whom died from cardiovascular disease, and 218 participants developed AFL. When examining the prognosis of each baseline pulmonary function category, participants with PRISm had higher risks of all-cause death (HR 2.20 [95%CI: 1.35 to 3.59]) and cardiovascular death (HR 4.07 [1.07 to 15.42]) than those with normal spirometry after adjusting for confounders. Moreover, the multivariable-adjusted risk of incident AFL was greater in participants with PRISm than in those with normal spirometry (HR 2.48 [1.83 to 3.36]). CONCLUSIONS: PRISm was associated with higher risks of all-cause and cardiovascular death and a greater risk of the development of AFL in a Japanese community. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

DOI： 10.1164/rccm.202110-2302OC

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Language：English   Publisher：(一社)日本動脈硬化学会  

心血管疾患の既往がない成人被験者2454名(男性1026名、女性1428名、平均58.2±11.1歳)を対象に、Cox比例ハザードモデルを用いてアテローム動脈硬化性心血管疾患(ASCVD)発症のリスク予測モデルを開発し、妥当性を検証した。対象は久山町研究に参加した40歳から84歳までの一般住民で、ASCVDは冠状動脈性心疾患またはアテローム血栓性脳梗塞と定義した。平均追跡期間は24年で、ASCVDは270名で初発した。発生率は1000人あたり5.8人年であった。リスク予測モデルの予測因子として年齢、性別、収縮期血圧、糖尿病、血中HDLコレステロール、LDLコレステロール、蛋白尿、喫煙習慣、定期的な運動を選択した。上記の変数を組み込んで10年後のASCVD発症予測モデルを構築し、簡便なリスクスコアを作成した。C統計量により妥当性を評価したところ、ASCVD発症リスク予測モデル(0.786)と簡便なリスクスコア(0.789)のいずれも優れた識別能を呈した。またGreenwood-Nam-D' Agostino検定で良好なキャリブレーションが確認された(それぞれP=0.29とP=0.52)。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Atherosclerosis Society  

<p> <b>Aim:</b> Secular trends in the risk of recurrent stroke have been reported in several epidemiological studies worldwide, but this issue has not been investigated in general Japanese populations. We examined the trends in the 5-year risk of recurrent stroke over a half century using community-based prospective data in Japan.</p><p><b>Methods:</b> We established 4 cohort studies in 1961, 1974, 1988, and 2002. To examine the risk of recurrent stroke, participants who developed stroke during a 10-year follow-up period in each cohort were followed-up for 5 years from the date of first onset. A total of 154 (first sub-cohort: 1961-1971), 144 (second sub-cohort: 1974-1984), 172 (third sub-cohort: 1988-1998), and 146 (fourth sub-cohort: 2002-2012) participants from each cohort were enrolled in the present study. The 5-year cumulative risk of recurrent stroke was compared among the sub-cohorts using the Kaplan-Meier method and the age- and sex-adjusted Cox proportional hazards model.</p><p><b>Results:</b> The risks of recurrent stroke after any stroke and ischemic stroke decreased significantly from the first to the third sub-cohort, but they did not clearly change from the third to the fourth sub-cohort. The risk of recurrent stroke after hemorrhagic stroke decreased mainly from the first to the second sub-cohort and there was no apparent decrease from the second to the fourth sub-cohort. These trends were substantially unchanged after adjusting for age and sex.</p><p><b>Conclusions:</b> In the Japanese community, the risk of recurrent stroke decreased mainly from the 1960s to 1990s, but there was no apparent decrease in recent years.</p>

DOI： 10.5551/jat.63344

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Language：Others   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Information regarding the influence of serum uric acid (SUA) levels on pathological changes in the kidney is limited. In this study, we examined the association between SUA levels and pathological findings of nephrosclerosis in population-based autopsy samples. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; A total of 923 deceased individuals in a Japanese community underwent autopsy examinations between 1974 and 1994. Of these, 547 individuals with available kidney tissues and health examination data within a median of 3 years before death were eligible for the present study. SUA levels were categorized into quintiles (Q1, 107–237; Q2, 238–279; Q3, 280–326; Q4, 327–380; Q5, 381–755 μmol/L). Advanced degrees of glomerular sclerosis, kidney arteriolar hyalinosis, and kidney arteriosclerosis were defined as the 90th percentile or more of a glomerular sclerosis index and an arteriolar hyalinosis index, and the 10th percentile or less of a wall-lumen ratio, respectively. A logistic regression model was used to evaluate odds ratios (ORs) and their 95% confidence intervals (CIs) of SUA levels on each kidney lesion. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Higher SUA levels were significantly associated with higher values of the age- and sex-adjusted glomerular sclerosis index and lower values of the wall-lumen ratio (both &lt;i&gt;p&lt;/i&gt; for trend &amp;#x3c;0.01). Individuals in the Q5 group had a significantly greater likelihood of advanced glomerular sclerosis (OR 7.19, 95% CI 2.42–21.38) and advanced kidney arteriosclerosis (OR 5.28, 95% CI 1.77–15.80) than individuals in the Q1 group after adjusting for potential covariates. There was no evidence of significant associations of SUA levels with either the arteriolar hyalinosis index or the presence of advanced arteriolar hyalinosis. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; Elevated SUA levels were significantly associated with advanced glomerular sclerosis and advanced kidney arteriosclerosis, but not with advanced arteriolar hyalinosis in community-based autopsy samples of Japanese.

DOI： 10.1159/000521426

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Language：English   Publisher：(一社)日本動脈硬化学会  

体重変化が、モデルから予測される心血管疾患(CVD)の包括的リスクと個々の心血管リスクの変化に及ぼす影響について検討した。久山町研究の縦断データを用いて、2002年と2007年の健康診断に参加した40～74歳の地域住民2140名を対象に解析を行った。BMI 25kg/m2以上を肥満とし、2002年と2007年のBMIにより、「安定肥満」(両年とも肥満)、「肥満から非肥満」、「非肥満から肥満」、「安定非肥満」(両年とも肥満)に分類した。CVDの推定累積リスクおよびCVDリスク因子の2002年から2007年にかけての変化を群間比較した。2140名を解析対象とした。CVDの推定リスクは、2007年にかけて全ての群で増加した。CVDの推定リスクの増加は、「肥満から非肥満」群で最も小さく、「非肥満から肥満」群で最も大きかった。「肥満から非肥満」群は「安定肥満」群よりもウエスト周囲長、血圧、空腹時血糖値、血清HDLコレステロール値、血清トリグリセリド値、肝酵素の望ましい変化量が大きかった。全変数について、「非肥満から肥満」群と「安定非肥満」群では逆の傾向が認められた。以上から、肥満者での減量および非肥満者での過剰な体重増加の回避と、CVD包括的リスクおよび個々のCVDリスク要因に望ましい関連が認められた。

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Language：Others   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/jcpe.13593

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DOI： 10.1038/s41440-021-00673-7

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DOI： 10.1016/j.jjcc.2021.03.014

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DOI： 10.1253/circj.CJ-20-0794

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DOI： 10.1253/circj.CJ-20-0751

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DOI： 10.1016/j.ekir.2021.01.006

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DOI： 10.1186/s12199-021-00970-0

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DOI： 10.1097/HJH.0000000000002693

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DOI： 10.1093/jn/nxaa382

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DOI： 10.1002/dad2.12221

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Atherosclerosis Society  

<p><b>Aim:</b>To develop and validate a new risk prediction model for predicting the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) in Japanese adults. </p><p><b>Methods:</b> A total of 2,454 participants aged 40–84 years without a history of cardiovascular disease (CVD) were prospectively followed up for 24 years. An incident ASCVD event was defined as the first occurrence of coronary heart disease or atherothrombotic brain infarction. A Cox proportional hazards regression model was used to construct the prediction model. In addition, a simplified scoring system was translated from the developed prediction model. The model performance was evaluated using Harrell’s C statistics, a calibration plot with the Greenwood-Nam-D’Agostino test, and a bootstrap validation procedure. </p><p><b>Results:</b> During a median of a 24-year follow-up, 270 participants experienced the first ASCVD event. The predictors of the ASCVD events in the multivariable Cox model included age, sex, systolic blood pressure, diabetes, serum high-density lipoprotein cholesterol, serum low-density lipoprotein cholesterol, proteinuria, smoking habits, and regular exercise. The developed models exhibited good discrimination with negligible evidence of overfitting (Harrell’s C statistics: 0.786 for the multivariable model and 0.789 for the simplified score) and good calibrations (the Greenwood-Nam-D’Agostino test: <i>P</i>=0.29 for the multivariable model, 0.52 for the simplified score). </p><p><b>Conclusion:</b> We constructed a risk prediction model for the development of ASCVD in Japanese adults. This prediction model exhibits great potential as a tool for predicting the risk of ASCVD in clinical practice by enabling the identification of specific risk factors for ASCVD in individual patients. </p>

DOI： 10.5551/jat.61960

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Atherosclerosis Society  

<p><b>Aim:</b> We investigated the influence of weight change on concurrent changes in predicted cardiovascular disease (CVD) risk and individual CVD risk factors over time. </p><p><b>Methods:</b> A total of 2,140 community-dwellers aged 40–74 years participated in both 2002 and 2007 health examinations. Obesity was defined as body mass index ≥ 25 kg/m². Weight trajectories were classified as: “stable obese” (obese at both examinations), “obese to nonobese” (obese in 2002 but nonobese in 2007), “nonobese to obese” (nonobese in 2002 but obese in 2007), or “stable nonobese” (nonobese at both examinations). We compared changes in the model-predicted risk for CVD and individual CVD risk factors across weight-change categories. </p><p><b>Results:</b> The predicted risk for CVD increased during 5 years in all groups; the increment in the predicted risk for CVD was smallest in the obese to nonobese participants and steepest in the nonobese to obese subjects. Compared with the stable obese participants, the obese to nonobese participants had greater favorable changes in waist circumferences, blood pressure, fasting plasma glucose, serum high-density lipoprotein cholesterol, serum triglycerides, and liver enzymes. For all these parameters, opposite trends were observed when comparing the nonobese to obese participants with the stable nonobese group. </p><p><b>Conclusions:</b> We demonstrated the favorable association of losing weight in obese people and avoiding excessive weight gain in nonobese people with global risk of future CVD and individual CVD risk factors in a real-world setting. The findings could improve behavioral lifestyle interventions that provide information on the health consequences of weight change at health checkups. </p>

DOI： 10.5551/jat.59394

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DOI： 10.1016/j.atherosclerosis.2020.08.016

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DOI： 10.3390/nu12103160

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DOI： 10.1111/joor.13039

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AIMS/INTRODUCTION: The investigation of the influence of dietary fiber intake on the incidence of type 2 diabetes in a general Japanese population. MATERIALS AND METHODS: A total of 1,892 individuals aged 40-79 years without diabetes at baseline were prospectively followed up for 14 years. The glucose tolerance status of participants was defined by a 75-g oral glucose tolerance test with the 1998 World Health Organization criteria. Dietary fiber intake was estimated by a semiquantitative food frequency questionnaire and divided to quintile levels separately by sex. A Cox proportional hazards model was applied for computing the hazard ratios and their 95% confidence intervals for the incidence of diabetes. RESULTS: During the follow-up period, 280 participants had developed diabetes. The age-adjusted cumulative diabetes incidence decreased significantly with higher total dietary fiber intake (P-for trend = 0.01). Participants in the highest quintile of total dietary fiber intake had a 0.53-fold (95% confidence interval 0.31-0.90) lower risk of developing diabetes than those in the lowest quintile after for the adjustment with potential confounding factors. Total dietary fiber intake showed a moderate positive correlation to the intake of soybean and soybean products, green vegetables, and other vegetables. Similar associations with diabetes and food sources were observed for both of the soluble and insoluble dietary fiber intake. CONCLUSIONS: The present study showed that higher dietary fiber intake was associated with a lower risk of type 2 diabetes in a general Japanese population. The intake of high dietary fiber foods might be useful for diabetes prevention.

DOI： 10.1111/jdi.13377

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DOI： 10.1038/s41440-020-0530-1

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DOI： 10.1212/WNL.0000000000009917

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DOI： 10.1136/bmjdrc-2019-001156

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DOI： 10.5551/jat.51961

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DOI： 10.1016/j.ijcard.2020.06.018

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DOI： 10.1038/s41440-019-0390-8

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DOI： 10.1136/jnnp-2019-322366

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DOI： 10.1038/s41440-019-0390-8

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DOI： 10.1186/s13063-019-3820-7

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DOI： 10.1161/JAHA.119.013628

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DOI： 10.1212/WNL.0000000000008464

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DOI： 10.1161/JAHA.119.013628

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DOI： 10.1212/WNL.0000000000008464

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We examined the association between serum concentrations of β-alanine, a metabolite of carnosine and anserine, and the risk of dementia in a general population of elderly Japanese persons. In 2007, 1,475 residents of Hisayama, Japan, aged 60-79 years and without dementia were divided into 4 groups according to quartiles of serum β-alanine concentrations (quartile 1, lowest; quartile 4, highest) and followed for a median of 5.3 years. During follow-up, 117 subjects developed all-cause dementia (Alzheimer in 77 cases and vascular dementia in 31). The risk of all-cause dementia decreased with increasing serum β-alanine levels after adjustment for potential confounding factors (quartile 2, hazard ratio (HR) = 0.73 (95% confidence interval (CI): 0.45, 1.18); quartile 3, HR = 0.50 (95% CI: 0.28, 0.89); quartile 4, HR = 0.50 (95% CI: 0.27, 0.92); P = 0.01 for trend). A similar inverse association was observed for Alzheimer disease (quartile 2, HR = 0.78 (95% CI: 0.44, 1.38); quartile 3, HR = 0.53 (95% CI: 0.26, 1.06); quartile 4, HR = 0.53 (95% CI: 0.25, 1.10); P = 0.04 for trend) but not for vascular dementia. We found that higher serum β-alanine levels were significantly associated with lower risks of all-cause dementia and Alzheimer disease. Because serum β-alanine levels reflect intakes of carnosine/anserine, higher intakes of carnosine/anserine might be beneficial for the prevention of dementia.

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DOI： 10.1093/aje/kwz116

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DOI： 10.1016/j.atherosclerosis.2018.10.014

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DOI： 10.1038/s41440-018-0096-3

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DOI： 10.1080/10641963.2017.1324476

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DOI： 10.1161/CIRCULATIONAHA.116.025667

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DOI： 10.1080/10641963.2016.1200605

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DOI： 10.2169/internalmedicine.55.4524

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DOI： 10.1038/hr.2016.73

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DOI： 10.1253/circj.CJ-16-0405

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DOI： 10.2169/internalmedicine.55.4524

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DOI： 10.1253/circj.CJ-16-0405

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DOI： 10.1038/hr.2015.35

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DOI： 10.3109/10641963.2015.1057831

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DOI： 10.1038/hr.2015.35

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DOI： 10.3109/10641963.2015.1057831

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DOI： 10.3109/10641963.2013.846360

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DOI： 10.3109/10641963.2013.846360

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DOI： 10.1253/circj.cj-11-0592

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DOI： 10.1136/bmjopen-2011-000133

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