研究者詳細 - 岡村　智教

論文 - 岡村　智教

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Relation between sleep quality and quantity, quality of life, and risk of developing diabetes in healthy workers in Japan

Hayashino Yasuaki, Fukuhara Shunichi, Suzukamo Yoshimi, Okamura Tomonori, Tanaka Taichiro, Ueshima Hirotsugu

BMC Public Health 7 2007年

Background. The effect of sleep on the risk of developing diabetes has not been explored in an Asian population. The objective of this study is to investigate the effect of self-reported sleep duration and sleep quality on the risk of developing diabetes in a prospective cohort in Japan. Methods. Data were analyzed from the cohort of participants in a High-risk and Population Strategy for Occupational Health Promotion Study (HIPOP-OHP), conducted in Japan from the year 1999 until 2004. A Cox proportional hazard model was used to evaluate the association between sleep duration or sleep quality and the risk of diabetes. Results. Of 6509 participants (26.1% of women, 19-69 years of age), a total of 230 type 2 diabetes cases were reported over a median 4.2 years of follow-up. For participants who often experienced difficulty in initiating sleep, the multivariate-adjusted hazard ratios for diabetes were 1.42 (95%CI, 1.05-1.91) in participants with a medium frequency of difficulty initiating sleep, and 1.61 (95%CI, 1.00-2.58) for those with a high frequency, with a statistically significant linear trend. Significant association was not observed in the association between difficulty of maintaining sleep or duration of sleep, and risk of diabetes. Conclusion. Medium and high frequencies of difficulty initiating sleep, but not difficulty in maintaining sleep or in sleep duration, are associated with higher risks of diabetes in relatively healthy Asian workers, even after adjusting for a large number of possible further factors. © 2007 Hayashino et al; licensee BioMed Central Ltd.

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Higher levels of adiponectin in American than in Japanese men despite obesity

Kadowaki Takashi, Sekikawa Akira, Okamura Tomonori, Takamiya Tomoko, Kashiwagi Atsunori, Zaky Wahid R., Maegawa Hiroshi, El-Saed Aiman, Nakamura Yasuyuki, Evans Rhobert W., Edmundowicz Daniel, Kita Yoshikuni, Kuller Lewis H., Ueshima Hirotsugu

Metabolism: Clinical and Experimental 55 （ 12 ） 1561 - 1563 2006年12月

ISSN 0026-0495

Levels of adiponectin are inversely associated with obesity levels. We examined the levels of adiponectin in American (n = 98) and Japanese (n = 92) men aged 40 to 49 years. Contrary to our expectations, the American men had higher levels of adiponectin than the Japanese men (13.3 ± 5.8 vs 7.3 ± 4.2 (μg/mL) despite higher levels of obesity. Smaller areas of visceral adipose tissue in American than in Japanese men may have resulted in the higher levels of adiponectin. © 2006 Elsevier Inc. All rights reserved.

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Relationship between metabolic syndrome and Trp64Arg polymorphism of the β3-adrenergic receptor gene in a general sample

Tamaki Shinji, Nakamura Yasuyuki, Tabara Yasuharu, Okamura Tomonori, Kita Yoshikuni, Kadowaki Takashi, Tsujita Yasuyuki, Horie Minoru, Miki Tetsuro, Ueshima Hirotsugu

Hypertension Research 29 （ 11 ） 891 - 896 2006年11月

ISSN 0916-9636

It has been reported that the β3-adrenergic receptor gene (ADRB3) is associated with abnormal metabolic risk factors. Therefore, we examined whether the Trp64Arg polymorphism of ADRB3 affects the occurrence of metabolic syndrome (MS). The participants were 2,395 subjects who underwent a medical examination in Shigaraki in Shiga, Japan. Among them, 1,416 subjects who gave informed consent for genetic analysis and were not receiving treatment for hypertension, diabetes, or hyperlipidemia were enrolled in this study. MS was diagnosed in 86 (16.0%) of 537 men, and 8 (0.9%) of 879 women. There was no significant relationship between ADRB3 polymorphism and the frequency of MS. Multiple logistic regression analysis including smoking, sex, and age as confounding factors showed no interaction between MS and ADRB3 polymorphism (odds ratio: 0.94; 95% confidence interval: 0.59-1.49; p=0.78). Subjects were also analyzed according to differences in the number of abnormal metabolic risk factors. However, there was no significant relationship between ADRB3 polymorphism and the number of such factors. In conclusion, in a general sample, the frequency of MS as 16.0% in men, and 0.9% in women. There was no relationship between ADRB3 polymorphism and MS.

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Medical costs of patients with hypertension and/or diabetes

Nakamura Koshi, Okamura Tomonori, Kanda Hideyuki, Hayakawa Takehito, Okayama Akira, Ueshima Hirotsugu

Journal of Hypertension 24 （ 11 ） 2305 - 2309 2006年11月

ISSN 0263-6352

BACKGROUND AND METHODS: A cohort study investigating medical costs associated with the combination of hypertension and diabetes was conducted. The participants included 4535 community-dwelling Japanese individuals, aged 40-69 years, who were classified into the following four categories: 'Neither hypertension nor diabetes', 'Hypertension alone', 'Diabetes alone' or 'Both hypertension and diabetes'. Medical costs per person per month were compared among the four categories. RESULTS AND CONCLUSION: Of the study population, 1.3% had both hypertension and diabetes. During the 10-year follow-up period, participants with both hypertension and diabetes incurred higher medical costs, as compared with those without hypertension, diabetes or their combination, even after adjustment for other confounding factors. © 2006 Lippincott Williams & Wilkins, Inc.

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Body mass index and risk of stroke mortality among a random sample of Japanese adults

Oki Izumi, Nakamura Yosikazu, Okamura Tomonori, Okayama Akira, Hayakawa Takehito, Kita Yoshikuni, Ueshima Hirotsugu, Iimura Osamu, Omae Teruo, Ueda Kazuo, Yanagawa Hiroshi, Horibe Hiroshi, Kodama Kazunori, Kasagi Fumlyoshi, Tanihara Shinichi, Saito Shigeyuki, Sakata Kiyomi, Kakuno Fumihiko, Takeuchi Toshihiro, Hasebe Mitsuru, Kusano Fumitsugu, Kawamoto Takahisa, Minowa Masumi, Kawaminami Katsuhiko, Choudhury Sohel R., Kiyohara Yutaka, Iida Minoru, Hashimoto Tsutomu, Terao Atsushi, Sawai Koryo, Shibata Shigeo

Cerebrovascular Diseases 22 （ 5-6 ） 409 - 415 2006年10月

ISSN 1015-9770

Background: The relationship between body mass index (BMI) and stroke mortality remains unclear. The aim of the present study was to elucidate the relationship between BMI and stroke death in a representative cohort of Japanese men and women. Methods: We analyzed a database of 9,526 men and women aged 30 years and older who were randomly selected throughout Japan in 1980. These individuals had no history of stroke and were followed for 19 years. Hazard ratios (HR) and their 95% confidence intervals (CI) of deaths due to total stroke, cerebral infarction, and intracerebral hemorrhage were examined using Cox's proportional hazards regression models of BMI levels. Results: A U-shaped association between BMI and cerebral infarction mortality was observed. Participants with the highest BMI category (BMI ≥ 30.0) showed a significantly highest HR for cerebral infarction (HR 2.46, 95% CI 1.01-5.99). The excess risk at the lower extreme of the BMI was confined to men. These associations did not change after excluding deaths occurring in the first 2 years of follow-up. Conclusions: In the Japanese general population, a U-shaped association between BMI and cerebral infarction mortality was found and the excess risk at the lower extreme of the BMI was confined to men. Copyright © 2006 S. Karger AG.

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Erratum

Nakamura Koshi, Okamura Tomonori, Hayakawa Takehito, Kadowaki Takashi, Kita Yoshikuni, Okayama Akira, Ueshima Hirotsugu

Hypertension Research 29 （ 10 ） 833 2006年10月

ISSN 0916-9636

Continuation of smoking cessation and following weight change after intervention in a healthy population with high smoking prevalence

Kadowaki Takashi, Watanabe Makoto, Okayama Akira, Hishida Kayoko, Okamura Tomonori, Miyamatsu Naomi, Hayakawa Takehito, Kita Yoshikuni, Ueshima Hirotsugu

Journal of Occupational Health 48 （ 5 ） 402 - 406 2006年09月

ISSN 1341-9145

Smoking prevalence among males is conspicuously high in Asian countries including Japan. There are few prospective intervention studies on the duration of smoking cessation within regions with a high prevalence of smokers, such as Asia. We investigated the extent to which subjects continued abstaining from smoking after receiving smoking cessation support provided for all smokers in an occupational setting, regardless of their willingness to quit smoking. The subjects were 251 male workers who were smokers and had received a smoking cessation intervention in 1997 in an occupational setting. Smoking cessation rates and body mass index (BMI) at 10, 18, 30, 42, 54, and 66 months after the initial intervention were confirmed during annual health check-ups. Those who quit smoking following the intervention and continuously abstained from smoking throughout the study period were separately examined for BMI. After five years, 10.6% of the smokers continued smoking cessation. Of the abstainers who quit following the intervention, the abstinence rate decreased in the first and second year, but it stabilized at approximately 45% after the third year. High nicotine dependence and a selfreported lack of willingness to quit smoking did not lower long-term abstinence rates. Abstainers initially gained 1.55 BMI on average, but decreased the weight gain to 0.96 BMI over six years. Introducing smoking cessation support without nicotine replacement therapy is an effective long-term strategy in a healthy population with a high smoking prevalence. Abstainers maintain their smoking cessation if they refrain from smoking for three years.

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Alcohol Consumption and Coronary Artery Calcium in Middle-Aged Japanese Men

Okamura Tomonori, Kadowaki Takashi, Sekikawa Akira, Murata Kiyoshi, Miyamatsu Naomi, Nakamura Yasuyuki, El-Saed Aiman, Kashiwagi Atsunori, Maegawa Hiroshi, Nishio Yoshihiko, Takamiya Tomoko, Kanda Hideyuki, Mitsunami Kenichi, Kita Yoshikuni, Edmundowicz Daniel, Tamaki Shinji, Tsujita Yasuyuki, Kuller Lewis H., Ueshima Hirotsugu

American Journal of Cardiology 98 （ 2 ） 141 - 144 2006年07月

ISSN 0002-9149

Epidemiologic studies have investigated the relation between alcohol intake and coronary calcification, with controversial results. Furthermore, the influence of heavy drinking has not been well elucidated. In the present study, a random sample of community-based Japanese men aged 40 to 49 years without a history of cardiovascular disease (n = 245) were examined for coronary artery calcium (CAC) determined by electron-beam computed tomography and drinking status. There was a J-shaped association between alcohol intake and CAC. There was an increase of CAC in heavy drinkers (≥46 g/day), and participants who were drinking ≥69 g/day showed a significant increase in CAC compared with never drinkers after adjusting for other cardiovascular risk factors. © 2006 Elsevier Inc. All rights reserved.

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Japanese men have larger areas of visceral adipose tissue than Caucasian men in the same levels of waist circumference in a population-based study

Kadowaki T., Sekikawa A., Murata K., Maegawa H., Takamiya T., Okamura T., El-Saed A., Miyamatsu N., Edmundowicz D., Kita Y., Sutton-Tyrrell K., Kuller L. H., Ueshima H.

International Journal of Obesity 30 （ 7 ） 1163 - 1165 2006年07月

ISSN 0307-0565

Visceral adipose tissue (VAT) is an independent risk factor for metabolic and cardiovascular disorders. There has been no study that demonstrated different abdominal fat distribution between Asian and Caucasian men. As the Japanese are less obese but more susceptible to metabolic disorders than Caucasians, they may have larger VAT than Caucasians at similar levels of obesity. We compared the abdominal fat distribution of the Japanese (n=239) and Caucasian-American (n=177) men aged 40-49 years in groups stratified by waist circumference in a population-based sample. We obtained computed tomography images and determined areas of VAT and subcutaneous adipose tissue (SAT). We calculated VAT to SAT ratio (VSR). The Japanese men had a larger VAT and VSR in each stratum, despite substantially less obesity overall. In multiethnic studies, difference in abdominal fat distribution should be considered in exploring factors related to obesity. © 2006 Nature Publishing Group All rights reserved.

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Smoking scenes in popular Japanese serial television dramas

Kanda Hideyuki, Okamura Tomonori, Turin Tanvir Chowdhury, Hayakawa Takehito, Kadowaki Takashi, Ueshima Hirotsugu

Health Promotion International 21 （ 2 ） 98 - 103 2006年06月

ISSN 0957-4824

Japanese serial television dramas are becoming very popular overseas, particularly in other Asian countries. Exposure to smoking scenes in movies and television dramas has been known to trigger initiation of habitual smoking in young people. Smoking scenes in Japanese dramas may affect the smoking behavior of many young Asians. We examined smoking scenes and smoking-related items in serial television dramas targeting young audiences in Japan during the same season in two consecutive years. Fourteen television dramas targeting the young audience broadcast between July and September in 2001 and 2002 were analyzed. A total of 136 h 42 min of television programs were divided into unit scenes of 3 min (a total of 2734 unit scenes). All the unit scenes were reviewed for smoking scenes and smoking-related items. Of the 2734 3-min unit scenes, 205 (7.5%) were actual smoking scenes and 387 (14.2%) depicted smoking environments with the presence of smoking-related items, such as ashtrays. In 185 unit scenes (90.2% of total smoking scenes), actors were shown smoking. Actresses were less frequently shown smoking (9.8% of total smoking scenes). Smoking characters in dramas were in the 20-49 age group in 193 unit scenes (94.1% of total smoking scenes). In 96 unit scenes (46.8% of total smoking scenes), at least one non-smoker was present in the smoking scenes. The smoking locations were mainly indoors, including offices, restaurants and homes (122 unit scenes, 59.6%). The most common smoking-related items shown were ashtrays (in 45.5% of smoking-item-related scenes) and cigarettes (in 30.2% of smoking-item-related scenes). Only 3 unit scenes (0.1 % of all scenes) promoted smoking prohibition. This was a descriptive study to examine the nature of smoking scenes observed in Japanese television dramas from a public health perspective. © The Author (2006). Published by Oxford University Press. All rights reserved.

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Effectiveness of a low-intensity intra-worksite intervention on smoking cessation in Japanese employees

Tanaka Hideo, Yamato Hiroshi, Tanaka Taichiro, Kadowaki Takashi, Okamura Tomonori, Nakamura Masakazu, Okayama Akira, Ueshima Hirotsugu

Journal of Occupational Health 48 （ 3 ） 175 - 182 2006年05月

ISSN 1341-9145

To test the effectiveness of a low-intensity intervention program for smoking cessation targeting the worksite environment in employees who had a low readiness to quit, we conducted an intervention trial at six intervention and six control worksites in Japan. A total of 2,307 smokers at baseline who remained at their worksite throughout the three-year study period were analyzed (1,017 in intervention and 1,290 in control groups). The multi-component program at the worksites consisted of (1) presenting information on the harms of tobacco smoking and the benefits of cessation by posters, websites, and newsletters; (2) smoking cessation campaigns for smokers; (3) advice on designation of smoking areas; and (4) periodic site-visits of the designated smoking areas by an expert researcher. At baseline, the intervention and control groups each had high prevalence of immotive or precontemplation, that reflected low readiness to quit (71.5% and 73.2%, respectively). The smoking cessation rate, as not having smoked for the preceding six months or longer, assessed at 36 months after the baseline survey by a self-administered questionnaire was significantly higher in the intervention group than the control group (12.1%, vs. 9.4%, p=0.021). The intervention program still had a significant effect on the smoking cessation rate after multiple logistic regression analysis adjusted for sex, age, type of occupation, age of starting smoking, quit attempts in the past, number of cigarettes per day, and readiness to quit (odds ratio: 1.38, 95% confidence interval: 1.05-1.81, p=0.02). The cost per additional quitter due to the intervention was calculated to be ¥ 70,080. These findings indicate that this program is effective and can be implemented in similar workplaces where the prevalence of smoking is high and smokers' readiness to cease smoking is low.

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The determinants of plasma plasminogen activator inhibitor-1 levels differ for American and Japanese men aged 40-49

Takamiya Tomoko, Kadowaki Takashi, Zaky Wahid R., Ueshima Hirotsugu, Evans Rhobert W., Okamura Tomonori, Kashiwagi Atsunori, Nakamura Yasuyuki, Kita Yoshiyuki, Tracy Russell P., Kuller Lewis H., Sekikawa Akira

Diabetes Research and Clinical Practice 72 （ 2 ） 176 - 182 2006年05月

ISSN 0168-8227

Background: Elevated plasma plasminogen activator inhibitor-1 (PAI-1) levels were associated with higher incidence of type II diabetes. Elucidating the determinants of PAI-1 in various ethnicities may help to understand the susceptibility to developing diabetes. The aim of our study was to compare PAI-1 levels between Americans and the Japanese in the post-war generation and to elucidate the determinants of the PAI-1 levels. Methods: We conducted a cross-sectional study on a total of 198 men aged 40-49 in the US (Body mass index (BMI): 27.0 ± 3.3 kg/m²) and Japan (BMI: 23.3 ± 3.1 kg/m²). Examination included physique measurement (BMI and waist girth), blood analysis (lipid profiles, glucose, insulin, C-reactive protein, and PAI-1), and life-style assessment by self-administered questionnaires. Results: PAI-1 levels were significantly lower in American than in Japanese men, even after adjustment for age, waist girth, cigarette smoking, habitual alcohol drinking, and other factors. In the Americans, waist girth, insulin, and cigarette smoking were significantly associated with PAI-1 levels, while waist girth and triglycerides were significantly associated with PAI-1 levels in the Japanese. Conclusions: PAI-1 levels were significantly lower in American than in Japanese men and the determinants of PAI-1 levels differ for American and Japanese men aged 40-49. © 2005 Elsevier Ireland Ltd. All rights reserved.

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Electrocardiogram screening for left high R-wave predicts cardiovascular death in a Japanese community-based population

Nakamura Koshi, Okamura Tomonori, Hayakawa Takehito, Kadowaki Takashi, Kita Yoshikuni, Okayama Akira, Ueshima Hirotsugu, Iimura Osamu, Omae Teruo, Ueda Kazuo, Yanagawa Hiroshi, Horibe Hiroshi, Kodama Kazunori, Kasagi Fumiyoshi, Tanihara Shinichi, Saito Shigeyuki, Sakata Kiyomi, Nakamura Yoshikazu, Kakuno Fumihiko, Takeuchi Toshihiro, Hasebe Mitsuru, Kusuno Fumitsugu, Kawamoto Takahisa, Minowa Masumi, Iida Minoru, Hashimoto Tsutomu, Tanaka Shigemichi, Terao Atsushi, Kawaminami Katsuhiko, Sawai Koryo, Shibata Shigeo

Hypertension Research 29 （ 5 ） 353 - 360 2006年05月

ISSN 0916-9636

Little is known about the efficacy of left ventricular hypertrophy diagnosed by electrocardiography for predicting cardiovascular disease in a general Japanese population. In a large cohort of participants selected randomly from the overall Japanese population, we attempted to evaluate the usefulness of a high amplitude R-wave (left high R-wave) on the electrocardiogram for predicting cardiovascular death. A total of 6,688 Japanese (mean age, 50.7 years old; 57% women) free of previous cardiovascular disease and use of antihypertensive agents at baseline were followed for 10 years, from 1990 to 2000. Left high R-wave on the electrocardiogram (the Minnesota Code, 3-1 or 3-3) was found in 9.4% of the 6,688 participants, in 14.6% of the 2,413 hypertensives and in 4.1% of the 4,275 normotensives. During the follow-up period, 128 participants died due to cardiovascular disease. After adjustment for systolic blood pressure and other risk factors, left high R-wave conferred an increased risk of cardiovascular death; the hazard ratio among all the participants was 1.88 (95% confidence interval, 1.22-2.89; p<0.01), that among hypertensives was 1.97 (1.20-3.24; p=0.01), and that among normotensives was 1.66 (0.69-3.98; p=0.26). The population attributable risk percent of left high R-wave for cardiovascular death was 7.6% among all participants, 12.4% among hypertensives and 4.1% among normotensives. Left high R-wave on electrocardiogram, irrespective of the level of systolic blood pressure, was a predictive marker for cardiovascular death among community-dwelling Japanese.

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Age-specific effects of systolic and diastolic blood pressures on mortality due to cardiovascular diseases among Japanese men (NIPPON DATA80*)

Okayama Akira, Kadowaki Takashi, Okamura Tomonori, Hayakawa Takehito, Ueshima Hirotsugu

Journal of Hypertension 24 （ 3 ） 459 - 462 2006年03月

ISSN 0263-6352

Objective: To clarify the relationship between mortality due to cardiovascular diseases (CVD) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) in young and elderly Japanese men in the absence of antihypertensive treatments. Design: A 19-year cohort study using the 1980 National Survey of Cardiovascular Diseases and the identification of the underlying causes of death using national vital statistics data. Methods: In 1999, a 19-year follow-up study was conducted among participants randomly selected from the Japanese population for the 1980 National Survey of Cardiovascular Diseases. Among the male participants that were not receiving antihypertensive treatment, information was obtained for about 91.3% of the subjects (n = 3779). Age-adjusted mortality rates using the person-year method were calculated to compare the relationships of SBP and DBP levels with CVD mortality for different age groups (aged 30-64, 65-74, and 75 years or more). Results: The total number of observed person-years was 64 598 and the number of CVD-related deaths after 19 years was 253. Both SBP and DBP levels were significantly and linearly related to CVD mortality in the age groups 30-64 years (P < 0.001 and P = 0.01, respectively) and 65-74 years (P < 0.001 and P = 0.03, respectively). In the group of participants that were at least 75 years old, however, no significant increase in the relative risk of CVD was observed with increasing DBP levels (P = 0.156), whereas the relative risk of CVD increased significantly with increasing SBP levels (P = 0.038). Multivariate analysis adjusting for major risk factors confirmed these relationships. Standardized hazard ratios (95% confidence intervals) of SBP were 1.53 (1.19-1.96) for 30-64 year olds, 1.70 (1.31-2.20) for 64-74 year olds, and 1.23 (1.03-1.47) for participants 75 years old or more, whereas those of DBP were 1.52 (1.12-2.06), 1.60 (1.21-2.10), and 1.10 (0.94-1.28), respectively. Conclusions: These data show that elevated SBP is an independent risk factor for CVD mortality for Japanese men of all ages, whereas elevated DBP is not an independent risk factor for CVD mortality for elderly men. © 2006 Lippincott Williams & Wilkins.

Are comprehensive environmental changes as effective as health education for smoking cessation?

Kadowaki Takashi, Kanda H., Watanabe M., Okayama A., Miyamatsu N., Okamura T., Hayakawa T., Hishida K., Kita Y., Ueshima H.

Tobacco Control 15 （ 1 ） 26 - 29 2006年02月

ISSN 0964-4563

Objectives: To compare the effectiveness of health education on smoking cessation for all smokers regardless of their willingness to quit smoking and cumulative environmental changes including designation of smoking places, legislation, and price rise. Design: Comparison of smoking cessation rates over two time periods: the period of health education on smoking cessation (1997-1999), and the period of cumulative environmental changes (2002-2004). Setting: An occupational setting in a radiator manufacturing factory in Japan. Subjects: All habitual male smokers who remained in the worksite through the pertinent time period (n = 202 in the period of health education and n = 170 in the period of environmental changes). Main outcome measurements: Smoking cessation rates at the end of each time period. Results: The smoking cessation rates over the periods of health education and environmental changes were 8.9% and 7.1%, respectively. There was no difference between these two proportions in χ² test (p = 0.513). The age adjustment did not significantly alter the cessation rate. Conclusions: Cumulative environmental changes are fairly effective in promoting smoking cessation, and may yield similar smoking cessation rates as a health education intervention reaching all smokers regardless of their willingness to quit smoking.

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The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population

Okamura Tomonori, Hayakawa Takehito, Kadowaki Takashi, Kita Yoshikuni, Okayama Akira, Ueshima Hirotsugu

Atherosclerosis 184 （ 1 ） 143 - 150 2006年01月

ISSN 0021-9150

In populations with higher high-density lipoprotein cholesterol (HDL-C) levels and lower coronary mortality than Western populations, such as in Japan, the beneficial effect of HDL-C on all-cause mortality may be different. Furthermore, prior studies have not focused on very high level of HDL-C. A total of 7175 community Japanese residents without a past history of cardiovascular disease in 300 randomly selected districts were followed for 9.6 years. During follow-up, there were 636 deaths. The multivariate adjusted hazard ratio (HR) of HDL-C for all-cause or cause-specific mortality was calculated using a Cox proportional hazard model adjusted for other cardiovascular risk factors. The all-cause mortality suggested an inverse, graded relation with HDL-C categories; HR for the very high HDL-C category (≥1.82 mmol/L), compared with the reference group (1.04-1.55 mmol/L), was 0.73 (95% confidence interval, C.I., 0.50-1.06) for men, 0.63 (95% C.I., 0.41-0.94) for women and 0.70 (95% C.I., 0.53-0.93) when men and women were combined. Serum HDL-C as a continuous variable showed a significant inverse association with all-cause mortality. The cardiovascular mortality indicated a non-significant but inverse graded relation with HDL-C categories. As in the many Western populations, serum HDL-C levels were inversely associated with all-cause mortality in the Japanese general population. © 2005 Elsevier Ireland Ltd. All rights reserved.

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Chronic kidney disease is a risk factor for cardiovascular death in a community-based population in Japan - NIPPON DATA90

Nakamura Koshi, Okamura Tomonori, Hayakawa Takehito, Kadowaki Takashi, Kita Yoshikuni, Ohnishi Hirofumi, Saitoh Shigeyuki, Sakata Kiyomi, Okayama Akira, Ueshima Hirotsugu

Circulation Journal 70 （ 8 ） 954 - 959 2006年

ISSN 1346-9843

Background: Chronic kidney disease (CKD) has been identified as a risk factor for cardiovascular disease (CVD). Methods and Results: The risk of cardiovascular death was evaluated in a large cohort of participants selected randomly from the overall Japanese population. Participants (mean age, 52.4 years) free of previous CVD were followed up for 10 years. Glomerular filtration rate (GFR) was estimated using the abbreviated equation developed at the Cleveland Clinic laboratory for the Modification of Diet in Renal Disease study. Of the 7,316 participants, 6.7% had CKD with a GFR <60 at baseline. Even after adjustment for other risk factors, the presence of CKD conferred an increased risk of cardiovascular death with a hazard ratio of 1.20 (95% confidence interval, 0.82-1.76). Furthermore, a negative, graded correlation between GFR and risk of cardiovascular death was observed: 1.09 (0.72-1.64) for a 60≤ GFR <90, 1.15 (0.67-1.99) for a 45≤ GFR <60, 1.23 (0.49-3.09) for a 30≤ GFR <45, 5.52 (1.62-18.75) for a 15≤ GFR <30, 9.12 (2.12-39.29) for a GFR <15, as compared with normal kidney function (GFR ≥90). The proportion of excess cardiovascular death due to CKD was 1.3%. Conclusion: CKD was an independent risk factor for cardiovascular death in a community-dwelling Japanese population.

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Gender and age effects on ventricular repolarization abnormality in Japanese general carriers of a G643S common single nucleotide polymorphism for the KCNQ1 gene

Ozawa Tomoya, Ito Makoto, Tamaki Shinji, Yao Takenori, Ashihara Takashi, Kita Yoshikuni, Okamura Tomonori, Ueshima Hirotsugu, Horie Minoru

Circulation Journal 70 （ 6 ） 645 - 650 2006年

ISSN 1346-9843

Background: The KCNQ1 single nucleotide polymorphism (SNP), G643S, is known to be associated with secondary long QT syndrome (LQTS) and to cause a mild reduction in KCNQ1 current. However, the precise incidence and its association with QT intervals remain unknown in the greater cohort of the population in Japan. Methods and Results: The genotype was screened at codon 643 of KCNQ1 in 992 residents of a farming community. Eighty-eight individuals (female/male=52/36, 8.9%) were found to have a heterozygous G643S SNP. Matching both gender and age, we randomly selected 243 control (G643G) cases and compared the electrocardiogram parameters in both groups; QT, QTf (QT corrected by Fridericia's formula) intervals, the peak and the end of the T wave (Tpe) interval, and the Tpe/QT ratio. The latter 2 reflect the transmural dispersion of ventricular repolarization (TDR). In G643S carriers, both Tpe and Tpe/QT were significantly longer than in noncarriers, without significant QT prolongation. Both genders showed a tendency for an increase in QTf with aging. In females, both Tpe and Tpe/QT showed a similar significant increase with age, which was not observed in males. Conclusions: In elderly females, G643S might be an independent risk factor for secondary LQTS by causing a greater TDR.

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Combined cardiovascular risk factors and outcome - NIPPON DATA80, 1980-1994

Nakamura Yasuyuki, Yamamoto Takako, Okamura Tomonori, Kadowaki Takashi, Hayakawa Takehito, Kita Yoshikuni, Saitoh Shigeyuki, Okayama Akira, Ueshima Hirotsugu

Circulation Journal 70 （ 8 ） 960 - 964 2006年

ISSN 1346-9843

Background: To examine the prognostic significance of the high-risk group with combined cardiovascular risk factors in the Japanese, we analyzed the relationship between the high-risk group with combined risks and coronary heart disease (CHD) and stroke mortality using the NIPPON DATA80 database. Methods and Results: At baseline in 1980, those of age ≥30 years were randomly selected and 4,144 men and 5,318 women without CHD and/or stroke at baseline were followed for 14 years. The cutoff values for risk components obtained heuristically by Cox analysis were hypertension (systolic ≥130, or diastolic ≥85 mmHg, or on antihypertensive drugs), hypercholesterolemia (total cholesterol ≥200 mg/dl), hyperglycemia (≥130 mg/dl, or self-reported diabetes) and obesity (body mass index ≥27 kg/m²). Subjects were divided into 3 groups (0, 1-2 and 3-4 risks). Compared with those men in the risk 0 group, the hazard ratios in men in the risk 3-4 for CHD mortality was 8.04 (95% confidence interval: 1.03-62.6), and the stroke mortality was 5.06 (1.53-16.7). In women, no statistically significant difference was found due to a lesser number of events. Conclusion: The high-risk group with combined risk factors is important risk for Japanese men.

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The value of combining serum alanine aminotransferase levels and body mass index to predict mortality and medical costs

Nakamura Koshi, Okamura Tomonori, Kanda Hideyuki, Hayakawa Takehito, Okayama Akira, Ueshima Hirotsugu, Yamashita Shigeo, Tominaga Yoshinori, Katsuyama Kazuaki, Kakuno Fumihiko, Kitanishi Machiko, Tobita Yukio, Okamura Kanehiro, Hatta Kiminobu, Okada Takao, Hatanaka Michiko

Journal of Epidemiology 16 （ 1 ） 15 - 20 2005年12月

ISSN 0917-5040

Background: Evidence suggests that the predictive value of serum alanine aminotransferase (ALT) levels for prognosis, measured by indices such as all-cause mortality and medical costs, may be modified by body mass index (BMI). However, the relationship between serum ALT and BMI has not been satisfactorily elucidated. Methods: Four thousand, five hundred and twenty-four community dwelling Japanese National Health Insurance beneficiaries, 40-69 years old, were classified into five categories according to their serum ALT levels (IU/L) (ALT<20, 20≤ALT<30, 30≤ALT<40, 40≤ALT<50 and 50≤ALT) and followed for 10 years. Hazard ratios for all-cause mortality, with reference to the lowest serum ALT category, and medical costs per person were evaluated for each serum ALT category after analyzing interactions between serum ALT levels and BMI for all-cause mortality and for medical costs. Results: A significant interaction between serum ALT levels and BMI was observed. In participants below the median BMI, positive, graded relationships were identified between serum ALT levels and all-cause mortality as well as between serum ALT levels and personal medical costs. The multivariate-adjusted hazard ratio in the "50≤ALT" category showed an approximately 8-fold increase. However, in the participants at or above the median BMI, no significant relationships between serum ALT levels and all-cause mortality or personal medical costs were identified. Conclusions: In these Japanese participants, the predictive value of serum ALT levels for prognosis was more evident if BMI was taken into account. A combination of high serum ALT levels and below median BMI was associated with excess mortality and medical cost. Copyright © 2006 by the Japan Epidemiological Association.

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岡村 智教

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岡村　智教

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