研究者詳細 - 宮川　尚子

論文 - 宮川　尚子

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一般国民における循環器疾患危険因子の認知度および危険因子保有と認知度との関連　NIPPON DATA2010

永井雅人, 大久保孝義, 門田文, 宮川尚子, 村上義孝, 高嶋直敬, 奥田奈賀子, 東山綾, 早川岳人, 藤吉朗, 中村好一, 岡村智教, 上島弘嗣, 岡山明, 三浦克之

日本循環器病予防学会誌（(一社)日本循環器病予防学会） 51 （ 3 ） 166 - 175 2016年11月

研究論文（学術雑誌）, ISSN 1346-6267

【目的】循環器疾患危険因子の正しい知識を持つ者ほど、循環器疾患発症に予防的な健康行動をとることが報告されている。そこで本研究では本邦国民における循環器疾患危険因子の認知度を明らかにするとともに、危険因子保有と認知度との関連を検討した。【方法】平成22年国民健康・栄養調査に参加した全国300地区からの20歳以上の男女2,891名に対し、「心筋梗塞または脳卒中の原因として正しいと思うもの」を選択する質問調査を実施した。正答は高血圧、糖尿病、高コレステロール血症、喫煙、不整脈、HDLコレステロール低値である。ロジスティック回帰分析で、各危険因子の保有者をそれぞれの非保有者と比較し、危険因子を認知している年齢調整オッズ比を算出した。【結果】循環器疾患危険因子の認知度はそれぞれ、85.8%(高血圧)、72.6%(高コレステロール血症)、58.5%(喫煙)、49.8%(不整脈)、45.1%(糖尿病)、38.5%(HDLコレステロール低値)であった。男性では、各危険因子の非保有者を基準とした時、高血圧者の高血圧認知度、高コレステロール血症を有する者の高コレステロール血症認知度、過去の喫煙習慣を有する者で喫煙に関する認知度、糖尿病者の糖尿病認知度が有意に高かった(オッズ比1.33〜2.73)。女性では、高コレステロール血症を有する者の高コレステロール血症認知度、過去の喫煙習慣を有する者で喫煙に関する認知度、糖尿病者の糖尿病認知度が有意に高かった(オッズ比1.54〜1.80)。【結論】循環器疾患危険因子の認知度は、高血圧で8割を超える一方、不整脈、糖尿病、HDLコレステロール低値では5割に満たなかった。また、危険因子保有者は保有する危険因子が循環器疾患危険因子であることを認知している傾向が観察されたが、その他の危険因子の認知度は非保有者と同程度、または低い傾向であった。国民に対する循環器疾患危険因子の周知が必要である。(著者抄録)

Relationship between non-high-density lipoprotein cholesterol and the long-term mortality of cardiovascular diseases: NIPPON DATA 90.

Ito T, Arima H, Fujiyoshi A, Miura K, Takashima N, Ohkubo T, Kadota A, Hayakawa T, Kita Y, Miyagawa N, Okayama A, Okamura T, Ueshima H, NIPPON DATA90 Research Group.

International journal of cardiology （ELSEVIER IRELAND LTD） 220 262 - 7 2016年10月

研究論文（学術雑誌）, 査読有り, ISSN 0167-5273

Background: Non-high-density lipoprotein (HDL) cholesterol level, generally less affected by fasting status or serum triglyceride levels, may be useful for predicting future cardiovascular events in daily clinical practice. This study aimed to investigate the role of non-HDL cholesterol in the development of fatal coronary events and stroke in the general Japanese population.
Methods and results: From the NIPPON DATA 90 prospective cohort study, 8383 participants were followed up for 20 years since 1990. After exclusion of 666 cases without lipid or covariates data, 561 cases who were 75 years old or older, 274 cases with history of cardiovascular disease, and 181 cases with lipid-lowering treatment, 6701 participants were included in this analysis. Non-HDL cholesterol was defined as total cholesterol minus HDL cholesterol. Outcomes were death from coronary heart disease and stroke. During the period, 69 participants died from coronary heart disease and 112 from stroke. Compared with participants with non-HDL cholesterol level b3.9 mmol/L, age- and sex-adjusted hazard ratios for mortality by coronary heart disease in those with non-HDL cholesterol levels of 3.9-4.3 mmol/L, 4.4-4.8 mmol/L and >= 4.9 mmol/L were 1.27 (95% confidence interval [CI] 0.65-2.49), 1.81 (95% CI 0.92-3.55) and 2.40 (95% CI 1.30-4.43), respectively (P trend = 0.010). This association remained significant even after adjusting for other cardiovascular risk factors (P trend = 0.010). There was no clear association between non-HDL cholesterol levels and mortality by stroke (P trend= 0.052).
Conclusions: Among the general Japanese population, non-HDL cholesterol levels were clearly associated with future mortality by coronary heart disease, but not by stroke. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

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Associations of serum LDL particle concentration with carotid intima-media thickness and coronary artery calcification.

Zaid M, Miura K, Fujiyoshi A, Abbott RD, Hisamatsu T, Kadota A, Arima H, Kadowaki S, Torii S, Miyagawa N, Suzuki S, Takashima N, Ohkubo T, Sekikawa A, Maegawa H, Horie M, Nakamura Y, Okamura T, Ueshima H, SESSA Research Group.

Journal of clinical lipidology （ELSEVIER SCIENCE INC） 10 （ 5 ） 1195 - 1202.e1 2016年09月

研究論文（学術雑誌）, 査読有り, ISSN 1933-2874

BACKGROUND: Low-density lipoprotein particle (LDL-P) has recently been found to be a stronger predictor of cardiovascular disease (CVD) than LDL-cholesterol (LDL-C).
OBJECTIVES: Whether LDL-P is associated with subclinical atherosclerosis, independent of LDLC, as well as other lipid measures has not been fully examined. We aimed to analyze LDL-P associations with measures of subclinical atherosclerosis.
METHODS: We examined 870 Japanese men randomly selected from Kusatsu City, Shiga, Japan, aged 40-79 years from 2006-2008, free of clinical CVD and not using lipid-lowering medication. Cross-sectional associations of lipid measures with carotid intima-media thickness (cIMT) and coronary artery calcification (CAC; >0 Agatston score) were examined.
RESULTS: LDL-P was significantly positively associated with cIMT and maintained this association after adjustments for LDL-C and other lipid measures. Although these lipid measures were positively associated with cIMT, model adjustment for LDL-P removed any significant relationships. Higher LDL-P was associated with a significantly higher odds ratio of CAC and further adjustment for LDL-C did not affect this relationship. In contrast, the LDL-C association with CAC was no longer significant after adjustment for LDL-P. Other lipid measures attenuated associations of LDL-P with CAC. Likewise, associations of these measures with CAC were attenuated when model adjustments for LDL-P were made.
CONCLUSIONS: In a community-based sample of Japanese men, free of clinical CVD, LDL-P was a robust marker for subclinical atherosclerosis, independent of LDL-C and other lipid measures. Associations of LDL-C and other lipid measures with either cIMT or CAC were generally not independent of LDL-P. (C) 2016 National Lipid Association. All rights reserved.

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Smoking, Smoking Cessation, and Measures of Subclinical Atherosclerosis in Multiple Vascular Beds in Japanese Men.

Hisamatsu T, Miura K, Arima H, Kadota A, Kadowaki S, Torii S, Suzuki S, Miyagawa N, Sato A, Yamazoe M, Fujiyoshi A, Ohkubo T, Yamamoto T, Murata K, Abbott RD, Sekikawa A, Horie M, Ueshima H, Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) Research GroupNakanoYasutakaOgawaEmikoMaegawaHiroshiMiyazawaItsukoMitsunamiKenichiNozakiKazuhikoShiinoAkihikoArakiIsaoTsuruTeruhikoToyamaIkuoOgitaHisakazuKuritaSouichiMaedaToshinagaMiyamatsuNaomiKitaToruKimuraTakeshiNishioYoshihikoNakamuraYasuyukiOkamuraTomonoriBarinas‐MitchellEmma J.M.EdmundowiczDanielOhkuboTakayoshiHozawaAtsushiOkudaNagakoHigashiyamaAyaNagasawaShinyaKitaYoshikuniMurakamiYoshitakaTakashimaNaoyukiKadowakiTakash.

Journal of the American Heart Association （WILEY-BLACKWELL） 5 （ 9 ） 2016年08月

研究論文（学術雑誌）, 査読有り, ISSN 2047-9980

Background-Smoking is an overwhelming, but preventable, risk factor for cardiovascular diseases (CVD), although smoking prevalence remains high in developed and developing countries in East Asia.
Methods and Results-In a population-based sample of 1019 Japanese men aged 40 to 79 years, without CVD, we examined cross-sectional associations of smoking status, cumulative pack-years, daily consumption, and time since cessation, with subclinical atherosclerosis at 4 anatomically distinct vascular beds, including coronary artery calcification, carotid intima-media thickness (CIMT) and plaque, aortic artery calcification (AoAC), and ankle-brachial index. Current, former, and never smoking were present in 32.3%, 50.0%, and 17.7%, respectively. Compared to never smokers, current smokers had significantly higher risks of subclinical atherosclerosis in all 4 circulations (eg, odds ratios for coronary artery calcification >0, 1.79 [95% CIs, 1.16-2.79]; CIMT >1.0 mm, 1.88 [1.02-3.47]; AoAC >0, 4.29 [2.30-7.97]; and ankle-brachial index <1.1, 1.78 [1.16-2.74]) and former smokers did in carotid and aortic circulations (CIMT >1.0 mm, 1.94 [1.13-3.34]; and AoAC >0, 2.55 [1.45-4.49]). Dose-response relationships of pack-years and daily consumption, particularly with CIMT, carotid plaque, AoAC, and ankle-brachial index, were observed among both current and former smokers, and even a small amount of pack-years or daily consumption among current smokers was associated with coronary artery calcification and AoAC, whereas time since cessation among former smokers was linearly associated with lower burdens of all atherosclerotic indices.
Conclusions-Cigarette smoking was strongly associated with subclinical atherosclerosis in multiple vascular beds in Japanese men, and these associations attenuated with time since cessation.

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Relationship of three different types of low-carbohydrate diet to cardiometabolic risk factors in a Japanese population: the INTERMAP/INTERLIPID Study.

Nakamura Y, Ueshima H, Okuda N, Miura K, Kita Y, Miyagawa N, Yoshita K, Nakagawa H, Sakata K, Saitoh S, Okamura T, Okayama A, Choudhry SR, Rodriguez B, Masaki KH, Chan Q, Elliott P, Stamler J

European journal of nutrition （SPRINGER HEIDELBERG） 55 （ 4 ） 1515 - 24 2016年06月

研究論文（学術雑誌）, 査読有り, ISSN 1436-6207

Purpose Low-carbohydrate diets (LCD) are a popular dietary strategy for weight reduction. The effects of LCD on long-term outcome vary depending on type of LCD, possibly due to the fact that effects on cardiometabolic risk factors may vary with different types of LCD. Accordingly, we studied these relations.
Methods We assessed serum concentrations of high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), high-sensitivity C-reactive protein (CRP), total cholesterol, glycated hemoglobin, and uric acid, and nutrient intakes by standardized methods in men and women ages 40-59 years from four population samples of Japanese in Japan (553 men and 544 women, combined). For people consuming usual, animal-based, and plant-based LCDs, we calculated LCD scores, based on relative level of fat, protein, and carbohydrate, by modifying the methods of Halton et al. Instead of calculating scores based on animal or vegetable fat, we used saturated fatty acids (SFA) or monounsaturated fatty acids (MUFA) + polyunsaturated fatty acids (PUFA).
Results In multivariate regression analyses with adjustment for site, age, sex, BMI, smoking, alcohol intake, physical activity, and years of education, all three LCD scores were significantly positively related to HDLc (all P < 0.001), but not to LDLc. The plant-based LCD score was significantly inversely related to log CRP (coefficient = -0.010, P = 0.018).
Conclusions All three LCD scores were significantly positively related to HDLc. The plant-based LCD score was significantly inversely related to CRP. Carbohydrate intake below 50 % of total energy with higher intakes of vegetable protein and MUFA + PUFA, and lower intakes of SFA may be favorable for reducing cardiometabolic risk factors.

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Lipoprotein-associated phospholipase A2 is related to risk of subclinical atherosclerosis but is not supported by Mendelian randomization analysis in a general Japanese population.

Ueshima H, Kadowaki T, Hisamatsu T, Fujiyoshi A, Miura K, Ohkubo T, Sekikawa A, Kadota A, Kadowaki S, Nakamura Y, Miyagawa N, Okamura T, Kita Y, Takashima N, Kashiwagi A, Maegawa H, Horie M, Yamamoto T, Kimura T, Kita T, ACCESS and SESSA Research Groups.

Atherosclerosis （ELSEVIER IRELAND LTD） 246 141 - 7 2016年03月

研究論文（学術雑誌）, 査読有り, ISSN 0021-9150

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an enzyme predominantly bound to low-density lipoprotein (LDL). Lp-PLA2 is recognized as playing a key role in inflammatory processes and the development of atherosclerosis. This study aimed to investigate whether Lp-PLA2 is related to subclinical atherosclerosis, independently from traditional risk factors, in a general Japanese population by analyses of both the observational study and Mendelian randomization using V279F polymorphism.
Methods and results: We cross-sectionally examined community-based sample of 929 Japanese men aged 40-79 years, without statin treatment, who were randomly selected from the resident registration. Multiple regression analyses of Lp-PLA2 activity and concentration were undertaken separately for men aged 40-49 years and 50-79 years, to clarify interactions of age and Lp-PLA2. Lp-PLA2 activity for men aged 50-79 years was significantly and positively related to intima-media thickness (IMT) (P = 0.013) and plaque index (P = 0.008) independent of traditional risk factors including small LDL particles, but not to coronary artery calcification (CAC) score. Associations with Lp-PLA2 concentration were qualitatively similar to those of activity. Corresponding relationships were not observed in men aged 40e49 years. Mendelian randomization analyses based on V279F genotype did not show any significant associations with subclinical atherosclerosis, although the homozygote and heterozygote of V279F showed low LpPLA2 activity and concentration.
Conclusions: Lp-PLA2 activity in Japanese men aged 50-79 years was associated significantly and positively with IMT and plaque in the carotid artery but Mendelian randomization did not support that LpPLA2 is a causative factor for subclinical atherosclerosis. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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Serum level of LOX-1 ligand containing ApoB is associated with increased carotid intima-media thickness in Japanese community-dwelling men, especially those with hypercholesterolemia LOX-1 ligand and IMT in Japanese.

Okamura T, Miura K, Sawamura T, Kadota A, Hisamatsu T, Fujiyoshi A, Miyamatsu N, Takashima N, Miyagawa N, Kadowaki T, Ohkubo T, Murakami Y, Nakamura Y, Ueshima H, SESSA Research Group.

Journal of clinical lipidology （ELSEVIER SCIENCE INC） 10 （ 1 ） 172 - 80.e1 2016年01月

研究論文（学術雑誌）, 査読有り, ISSN 1933-2874

BACKGROUND: The serum level of LOX-1 ligand containing ApoB (LAB) may reflect atherogenicity better than usual lipid parameters; however, the relationship between LAB and carotid intima-media thickness (IMT) was not clear even in Asian populations.
METHODS: A total of 992 community-dwelling Japanese men, aged 40 to 79 years, were enrolled in the present study. Serum LAB levels were measured by enzyme-linked immunosorbent assays (ELISAs) with recombinant LOX-1 and monoclonal anti-apolipoprotein B antibody.
RESULTS: Serum LAB levels (median [interquartile range], mu g cs/L) were 5341 mu g cs/L (4093-7125). The mean average IMT of the common carotid artery was highest in the fourth LAB quartile (842 mu m) compared with the first quartile (797 mu m) after adjustment for age, high-density lipoprotein cholesterol, triglyceride, body mass index, hypertension, diabetes, high sensitivity C-reactive protein, smoking, and alcohol drinking. However, this statistically significant difference was lost after further adjustment for total cholesterol (TC). After stratification using the combination of median LAB and hypercholesterolemia (serum TC >= 6.21 mmol/L and/or lipid-lowering medication), the adjusted mean average IMT (standard error) in the high LAB/hypercholesterolemia group was 886 mu m (12.7), 856 mu m (16.7) in the low LAB/hypercholesterolemia group, and 833 mu m (8.4) in the low LAB/normal cholesterol group (P = .004). After further adjustment for TC, mean average IMT in the high LAB group was significantly higher than that measured in the low LAB group in hypercholesterolemic participants not taking lipid-lowering medication.
CONCLUSION: Serum LAB was associated with an increased carotid IMT in Japanese men, especially those with hypercholesterolemia. (C) 2016 National Lipid Association. All rights reserved.

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Association of Total Energy Intake with 29-Year Mortality in the Japanese: NIPPON DATA80.

Nagai M, Ohkubo T, Miura K, Fujiyoshi A, Okuda N, Hayakawa T, Yoshita K, Arai Y, Nakagawa H, Nakamura K, Miyagawa N, Takashima N, Kadota A, Murakami Y, Nakamura Y, Abbott RD, Okamura T, Okayama A, Ueshima H, NIPPON DATA80 Research Group.

Journal of atherosclerosis and thrombosis （JAPAN ATHEROSCLEROSIS SOC） 23 （ 3 ） 339 - 54 2016年

研究論文（学術雑誌）, 査読有り, ISSN 1340-3478

Aim: In animals, dietary energy restriction is reported to increase longevity, whereas in humans, all cohort studies from Western countries have not shown an association between the low energy intake and longevity. We examined the association between total energy intake and longevity in Japan where dietary pattern is different from that in the West.
Methods: A total of 7,704 Japanese aged 30-69 years were followed from 1980 to 2009. Participants were divided into the quintiles of total energy (kcal/day) based on data collected from the National Nutrition Survey. Hazard ratios and 95% confidence intervals (CIs) were derived through the use of Cox proportional hazards models to compare the risk of death across and between the quintiles.
Results: There was a significant association between increased energy intake and all-cause mortality risk in only men (P for linear trend 0.008). In cause-specific analysis, compared with the lowest quintile, there was rise in coronary heart disease (CHD) mortality among men (HR; 2.63, 95% CI; 0.95-7.28, P for linear trend 0.016) and women (HR; 2.91, 95% CI; 1.02-8.29, P for linear trend 0.032) and cancer mortality among men (HR; 1.50, 95% CI; 0.999-2.24, P for linear trend 0.038) in the top quintile.
Conclusion: We observed significant associations of high energy intake with all-cause and cancer mortality among men and with CHD mortality among men and women. Further studies are needed to confirm the benefits of caloric restriction.

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Secular trends of the impact of overweight and obesity on hypertension in Japan, 1980-2010.

Nagai M, Ohkubo T, Murakami Y, Takashima N, Kadota A, Miyagawa N, Saito Y, Nishi N, Okuda N, Kiyohara Y, Nakagawa H, Nakamura Y, Fujiyoshi A, Abbott RD, Okamura T, Okayama A, Ueshima H, Miura K, NIPPON DATA80/90/2010 Research Group.

Hypertension research : official journal of the Japanese Society of Hypertension 38 （ 11 ） 790 - 5 2015年11月

研究論文（学術雑誌）, ISSN 0916-9636

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High-density lipoprotein particle concentration and subclinical atherosclerosis of the carotid arteries in Japanese men.

Zaid M, Fujiyoshi A, Miura K, Abbott RD, Okamura T, Takashima N, Torii S, Saito Y, Hisamatsu T, Miyagawa N, Ohkubo T, Kadota A, Sekikawa A, Maegawa H, Nakamura Y, Mitsunami K, Ueshima H, SESSA Research group.

Atherosclerosis （ELSEVIER IRELAND LTD） 239 （ 2 ） 444 - 50 2015年04月

研究論文（学術雑誌）, 査読有り, ISSN 0021-9150

Objective: The association of high-density lipoprotein particle (HDL-P) with atherosclerosis may be stronger than that of HDL-cholesterol (HDL-C) and independent of conventional cardiovascular risk factors. Whether associations persist in populations at low risk of coronary heart disease (CHD) remains unclear. This study examines the associations of HDL-P and HDL-C with carotid intima-media thickness (cIMT) and plaque counts among Japanese men, who characteristically have higher HDL-C levels and a lower CHD burden than those in men of Western populations.
Methods: We cross-sectionally examined a community-based sample of 870 Japanese men aged 40-79 years, free of known clinical cardiovascular disease (CVD) and not on lipid-lowering medication. Participants were randomly selected among Japanese living in Kusatsu City in Shiga, Japan.
Results: Both HDL-P and HDL-C were inversely and independently associated with cIMT in models adjusted for conventional CHD risk factors, including low-density lipoprotein cholesterol (LDL-C) and diabetes. HDL-P maintained an association with cIMT after further adjustment for HDL-C (P < 0.01), whereas the association of HDL-C with cIMT was noticeably absent after inclusion of HDL-P in the model. In plaque counts of the carotid arteries, HDL-P was significantly associated with a reduction in plaque count, whereas HDL-C was not.
Conclusion: HDL-P, in comparison to HDL-C, is more strongly associated with measures of carotid atherosclerosis in a cross-sectional study of Japanese men. Findings demonstrate that, HDL-P is a strong correlate of subclinical atherosclerosis even in a population at low risk for CHD. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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Fruit and vegetable intake and mortality from cardiovascular disease in Japan: a 24-year follow-up of the NIPPON DATA80 Study.

Okuda N, Miura K, Okayama A, Okamura T, Abbott RD, Nishi N, Fujiyoshi A, Kita Y, Nakamura Y, Miyagawa N, Hayakawa T, Ohkubo T, Kiyohara Y, Ueshima H, NIPPON DATA80 Research Group

European journal of clinical nutrition （NATURE PUBLISHING GROUP） 69 （ 4 ） 482 - 488 2015年04月

査読有り, ISSN 0954-3007

BACKGROUND/OBJECTIVES: There have been few studies on the association of fruit and vegetable (FV) intake with cardiovascular disease (CVD) risk in Asian populations where both dietary habits and disease structure are different from western countries. No study in Asia has found its significant association with stroke. We examined associations of FV intake with mortality risk from total CVD, stroke and coronary heart diseases (CHDs) in a representative Japanese sample.
METHODS: A total of 9112 participants aged from 24-year follow-up data in the NIPPON DATA80, of which baseline data were obtained in the National Nutrition Survey Japan in 1980, were studied. Dietary data were obtained from 3-day weighing dietary records. Participants were divided into sex-specific quartiles of energy adjusted intake of FV. Multivariate-adjusted hazard ratios (HRs) were calculated between strata of the total of FV intake, fruit intake and vegetable intake. The adjustment included age, sex, smoking, drinking habit and energy adjusted intakes of sodium and some other food groups.
RESULTS: Participants with higher FV intake were older, ate more fish, milk and dairy products and soybeans and legumes and ate less meat. Multivariate-adjusted HR (95% confidence interval; P; P for trend) for the highest versus the lowest quartile of the total of FV intake was 0.74 (0.61-0.91; 0.004; 0.003) for total CVD, 0.80 (0.59-1.09; 0.105; 0.036) for stroke and 0.57 (0.37-0.87; 0.010; 0.109) for CHD.
CONCLUSIONS: The results showed that higher total intake of FVs was significantly associated with reduced risk of CVD mortality in Japan.

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Association between Pulse Wave Velocity and Coronary Artery Calcification in Japanese men.

Torii S, Arima H, Ohkubo T, Fujiyoshi A, Kadota A, Takashima N, Kadowaki S, Hisamatsu T, Saito Y, Miyagawa N, Zaid M, Murakami Y, Abbott RD, Horie M, Miura K, Ueshima H, SESSA Research Group.

Journal of atherosclerosis and thrombosis （JAPAN ATHEROSCLEROSIS SOC） 22 （ 12 ） 1266 - 77 2015年

研究論文（学術雑誌）, 査読有り, ISSN 1340-3478

Aim: Pulse wave velocity (PWV) is a simple and valid clinical method for assessing arterial stiffness. Coronary artery calcification (CAC) is an intermediate stage in the process leading to overt cardiovascular disease (CVD) and an established determinant of coronary artery disease. This study aimed to examine the association between PWV and CAC in a population-based sample of Japanese men.
Methods: This is a cross-sectional study of 986 randomly selected men aged 40-79 years from Shiga, Japan. CVD-free participants were examined from 2006 to 2008. Brachial-ankle PWV (baPWV) was measured using an automatic waveform analyzer. CAC was assessed using computed tomography. Agatston scores >= 10 were defined as the presence of CAC.
Results: Prevalence of CAC progressively increased with rising levels of baPWV: 20.6%, 41.7%, 56.3%, and 66.7% across baPWV quartiles < 1378, 1378-1563, 1564-1849, and > 1849 cm/s (P < 0.001 for trend). Associations remained significant after adjusting for age and other factors, including body mass index, systolic blood pressure, pulse rate, total and high-density lipoprotein cholesterol, hemoglobin A1c, drinking, smoking and exercise status, and the use of medication to treat hypertension, dyslipidemia and diabetes (P = 0.042 for trend). The optimal cutoff level of baPWV to detect CAC was 1612 cm/s using receiver operating characteristic curve analysis.
Conclusions: Arterial stiffness as defined by an elevated baPWV is associated with an increased prevalence of CAC in a general population-based setting among Japanese men.

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Lipoprotein particle profiles compared with standard lipids in association with coronary artery calcification in the general Japanese population.

Hisamatsu T, Fujiyoshi A, Miura K, Ohkubo T, Kadota A, Kadowaki S, Kadowaki T, Yamamoto T, Miyagawa N, Zaid M, Torii S, Takashima N, Murakami Y, Okamura T, Horie M, Ueshima H, SESSA Research Group.

Atherosclerosis （ELSEVIER IRELAND LTD） 236 （ 2 ） 237 - 43 2014年10月

研究論文（学術雑誌）, 査読有り, ISSN 0021-9150

Objective: The utility of lipoprotein particle profiles measured by nuclear magnetic resonance (NMR) spectroscopy beyond standard serum lipids remains inconclusive. Furthermore, few studies have compared NMR measurements with standard lipids in association with coronary artery calcification (CAC) in Japanese, where the coronary atherosclerotic burden is low. We examined whether NMR-based lipoprotein particle profiles are associated with CAC, and compared them with standard lipid and lipid ratios in the Japanese general population.
Methods and Results: We conducted a cross-sectional study in 851 men aged 40-79 years without cardiovascular diseases and lipid-lowering therapies. Adjusted odds ratios (ORs) (95% confidence intervals) for the top versus the bottom quartile of NMR-measured particle concentrations were 2.01 (1.24-3.23) for low-density lipoprotein (LDL-P), 1.04 (0.62-1.75) for high-density lipoprotein (HDL-P), 1.82 (1.13-2.95) for very-low-density lipoprotein (VLDL-P), and 1.92 (1.18-3.17) for LDL-P/HDL-P ratio. Similarly adjusted ORs of NMR-measured particle sizes were 0.59 (0.36-0.97) for LDL-P, 0.66 (0.40-1.10) for HDL-P, and 0.67 (0.40-1.12) for VLDL-P. The corresponding ORs were 1.82 (1.14-2.90) for total cholesterol (TC), 2.06 (1.28-3.30) for low-density lipoprotein cholesterol (LDL-C), 0.56 (0.34-0.91) for high-density lipoprotein cholesterol (HDL-C), 2.02 (1.24-3.29) for triglycerides, 2.08 (1.29-3.36) for non-high-density lipoprotein cholesterol (non-HDL-C), 2.27 (1.37-3.78) for TC/HDL-C ratio, and 1.73 (1.06-2.85) for LDL-C/HDL-C ratio. After mutual adjustment for total LDL-P concentration and TC/HDL-C ratio or non-HDL-C, LDL-P was no longer associated, whereas TC/HDL-C ratio remained significantly associated with CAC.
Conclusions: In community-based Japanese men, the overall association of CAC with NMR-measured lipoprotein indices is comparable, but not superior, to that with standard lipids. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

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Low-carbohydrate diets and cardiovascular and total mortality in Japanese: a 29-year follow-up of NIPPON DATA80.

Nakamura Y, Okuda N, Okamura T, Kadota A, Miyagawa N, Hayakawa T, Kita Y, Fujiyoshi A, Nagai M, Takashima N, Ohkubo T, Miura K, Okayama A, Ueshima H, NIPPON DATA Research Group.

The British journal of nutrition （CAMBRIDGE UNIV PRESS） 112 （ 6 ） 916 - 24 2014年09月

研究論文（学術雑誌）, ISSN 0007-1145

Long-term safety of consuming low-carbohydrate diets (LCD) in Asian populations, whose carbohydrate intake is relatively high, is not known. In the present study, the association of LCD with CVD and total mortality was assessed using data obtained in the NIPPON DATA80 (National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged 1980) during 29 years of follow-up. At baseline in 1980, data were collected from study participants aged >= 30 years from randomly selected areas in Japan. LCD scores were calculated based on the percentage of energy as carbohydrate, fat and protein, estimated by 3 d weighed food records. A total of 9200 participants (56% women, mean age 51 years) were followed up. During the follow-up, 1171 CVD deaths (52% in women) and 3443 total deaths (48% in women) occurred. The multivariable-adjusted hazard ratio (HR) for CVD mortality using the Cox model comparing the highest v. lowest deciles of LCD score was 0 60 (95% CI 0 38, 0 94; P-trend = 0 021) for women and 0 78 (95% CI 0 58, 1 05; P-trend = 0 079) for women and men combined; the HR for total mortality was 0 74 (95% CI 0 57, 0 95; P-trend = 0 029) for women and 0 87 (95% CI 0 74, 1 02; P-trend = 0 090) for women and men combined. None of the associations was statistically significant in men. No differential effects of animal-based and plant-fish-based LCD were observed. In conclusions, moderate diets lower in carbohydrate and higher in protein and fat are significantly inversely associated with CVD and total mortality in women.

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High long-chain n-3 fatty acid intake attenuates the effect of high resting heart rate on cardiovascular mortality risk: a 24-year follow-up of Japanese general population.

Hisamatsu T, Miura K, Ohkubo T, Yamamoto T, Fujiyoshi A, Miyagawa N, Kadota A, Takashima N, Okuda N, Yoshita K, Kita Y, Murakami Y, Nakamura Y, Okamura T, Horie M, Okayama A, Ueshima H, NIPPON DATA80 Research Group.

Journal of cardiology （ELSEVIER SCIENCE BV） 64 （ 3 ） 218 - 24 2014年09月

研究論文（学術雑誌）, 査読有り, ISSN 0914-5087

Background: Increased resting heart rate (RHR) independently predicts cardiovascular mortality. Meanwhile, long-chain n-3 fatty acids (LCn3FAs) have a cardioprotective effect. Our aim was to evaluate whether higher LCn3FAs intake attenuates the elevated risk of cardiovascular mortality associated with increased RHR.
Methods: We conducted a population-based 24-year prospective cohort study of Japanese, whose LCn3FAs intake is relatively high. Study participants included 8807 individuals aged 30-95 years from randomly selected areas across Japan without cardiovascular diseases and anti-hypertensive drugs at baseline. The primary endpoint was cardiovascular mortality, and the secondary endpoints were cardiac and stroke mortality during 24 years of follow-up. Individual dietary LCn3FAs intake was estimated from household-based 3-day weighed food records. RHR was obtained from 3 consecutive R-wave intervals on 12-lead electrocardiography. Cox models were used to estimate the multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) adjusting for possible confounders.
Results: During the follow-up period, 617 cardiovascular deaths were observed. The median daily intake of LCn3FAs was 0.37% kcal (0.86 g/day). The interaction between dietary LCn3FAs intake and RHR in the risk of cardiovascular mortality was statistically significant (p = 0.033). The risk of cardiovascular mortality was significantly higher in the low-intake group (<0.37% kcal) with an RHR >85 beats/min (bpm) [hazard ratio (HR), 1.67; 95% confidence interval (CI), 1.15-2.43], but not in the high-intake group (>= 0.37% kcal) with an RHR >85 bpm (HR, 0.92; 95% CI, 0.61-1.38), compared with those in the high-intake group with an RHR <70 bpm. Similar results were observed with stroke mortality, but not with cardiac mortality.
Conclusions: The risk of cardiovascular mortality associated with increased RHR is elevated in participants with low dietary LCn3FAs intake, but not in participants with high dietary LCn3FAs intake in a representative Japanese general population. These results suggest that high dietary LCn3FAs intake may prevent cardiovascular mortality associated with increased RHR. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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Six random specimens of daytime casual urine on different days are sufficient to estimate daily sodium/potassium ratio in comparison to 7-day 24-h urine collections.

Iwahori T, Ueshima H, Miyagawa N, Ohgami N, Yamashita H, Ohkubo T, Murakami Y, Shiga T, Miura K

Hypertension research : official journal of the Japanese Society of Hypertension （NATURE PUBLISHING GROUP） 37 （ 8 ） 765 - 71 2014年08月

研究論文（学術雑誌）, 査読有り, ISSN 0916-9636

The objective of this study was to determine the optimal number and type of casual (spot) urine specimens required to estimate an individual's urinary sodium/potassium (Na/K) ratio. A total of 48 participants, 25 men and 23 women, aged between 25 and 59 years, was recruited from healthy volunteers. The Na/K ratio in each casual urine and 7-day 24-h urine sample was measured. Correlation analysis and the quality of agreement by the Bland and Altman method between casual urine and 24-h urine were analyzed. The mean Na/K ratio of 7-day 24-h urine was 4.3. The mean Na/K ratio of six random specimens of daytime (collected between 09 and 17 hours) casual urine correlated most strongly with the Na/K ratio of 7-day 24-h urine (r=0.87). The bias for the mean Na/K ratio between 7-day 24-h urine and daytime casual urine was almost negligible (0.03), and the quality of agreement for the mean of the six random, daytime casual urine specimens on different days was similar to that of the 2-day 24-h urine samples for estimating 7-day 24-h values. Our findings show that the mean Na/K ratio of six random daytime casual urine specimens on different days was a good substitute for the 2-day 24-h urine Na/K ratio.

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レセプト情報・特定健診等情報データベースを利用した滋賀県における循環器疾患危険因子の有病率、治療率、コントロール率

宮川尚子, 村上義孝, 岡山明, 角野文彦, 三浦克之

日本公衆衛生雑誌（日本公衆衛生学会） 61 （ 7 ） 333 - 341 2014年07月

研究論文（学術雑誌）, 筆頭著者, 査読有り, ISSN 0546-1766

目的生活習慣病の予防戦略立案において、循環器疾患危険因子の有病率、治療率およびそのコントロール率を性・年齢別に詳細に実態把握することは公衆衛生上重要である。高齢者の医療の確保に関する法律に基づく「レセプト情報・特定健診等情報データベース」の研究利用が可能になったことに伴い、滋賀県の特定健診全受診者における高血圧、糖尿病および高LDLコレステロール血症の有病率、治療率およびコントロール率を明らかにする。方法滋賀県在住の平成20年度特定健診受診者全員を対象者とし、本データベースにおける特定健診に関する提供データを用い、性・年齢別(5歳階級)に高血圧、糖尿病、高LDLコレステロール血症の有病率、治療率、コントロール率およびその95%信頼区間を算定した。コントロール率は、高血圧、糖尿病、高LDLコレステロール血症治療者のうち、検査値が基準値未満の者の割合とした。結果滋賀県在住の平成20年度特定健診受診者は211,976人であった。高血圧では男女ともに有病率(男性16〜60%、女性6〜58%)と治療率(男性23〜71%、女性24〜71%)は年齢上昇に伴い増加したが、コントロール率は約55%で年齢による違いがなかった。糖尿病では、男女の有病率(男性3〜15%、女性1〜10%)と男性の治療率(44〜62%)は年齢上昇に伴い増加し、コントロール率も男性で43〜51%、女性で32〜50%と緩やかに増加した。高LDLコレステロール血症では女性の有病率(16〜57%)と男女の治療率(男性6〜44%、女性6〜51%)、コントロール率が年齢上昇に伴い増加し、コントロール率は男性で63〜80%、女性で64〜77%と高い値を示した。結論レセプト情報・特定健診等情報データベースの特定健診データの活用により循環器疾患危険因子の有病率、治療率の詳細把握が可能になるとともに、これまで報告がなかったコントロール率が明らかとなり、本データベースは生活習慣病の実態把握に有効に利用できることが示された。(著者抄録)

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滋賀県野洲市における特定健診未受診理由を踏まえた特定健診受診勧奨手法の開発と受診率向上への効果

宮川尚子, 門田文, 清水めぐみ, 山澤幸子, 宇野裕子, 大黒清夏, 今堀初美, 山下亜希代, 櫻井真汐, 駒井文昭, 吉田和司, 門脇崇, 上島弘嗣, 三浦克之, 岡村智教

厚生の指標（(一財)厚生労働統計協会） 61 （ 4 ） 28 - 34 2014年04月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り, ISSN 0452-6104

目的平成20年度より開始された特定健診の平均受診率は市町村国保で31%前後であり,参酌標準の65%と大きく乖離している。健診受診率に影響を及ぼす要因について,受診勧奨施策の受診率への効果を検討した報告は少ない。本研究では,滋賀県野洲市において特定健診未受診者の未受診理由を明らかにし,得られた未受診理由を踏まえた健診受診勧奨手法を開発して,その効果について検討した。方法滋賀県野洲市の国保加入者を対象として,平成21年度に,前年度(平成20年度)の特定健診未受診者4,122人のうち無作為抽出した1,579人に郵送にて特定健診未受診の理由を尋ねる質問紙調査を実施し,760人(48.1%)から回答を得た。特定健診未受診理由に基づき,未受診理由を踏まえた受診勧奨手法を開発し,平成22年度に受診率向上のための対策を実施した。勧奨手法の効果は,健診実施期間が平成22年度と同じであった平成20年度の健診受診率との比較により評価した。結果健診未受診理由調査の結果,年齢層に関わらず「病院などにかかっている」「事業所健診等を受けている」「たまたま受け忘れた」「健康だから」が多く,中壮年層では加えて「受ける時間がない」も多かった。これらの未受診理由を踏まえて,個人と集団,それぞれへのアプローチを組み合わせた受診勧奨手法を開発した。個人へのアプローチとしては健診開始時に受診券と一緒に受診勧奨チラシを対象者全員に個別送付し,また健診期間の中間時点に,その時点の未受診者全員に再度,受診勧奨チラシと健診実施機関一覧表を個別送付した。集団に対するアプローチとしては同じく健診期間の中間時点で,「健康で自覚症状のない時の受診の重要性」をテーマにした記事の広報掲載とポスターの掲示を行った。この受診勧奨手法を用いた平成22年度の特定健診受診率は,用いていない平成20年度に比べて7.2%有意に上昇し,これは年齢層に分けても同様の結果であった。受診のきっかけを調査したところ,今回の受診勧奨手法をあげた者の割合は,ほぼ受診率の増加分に相当する660人(受診率8%相当)であった。結語特定健診未受診理由を踏まえた受診勧奨手法を開発し,その効果を評価した。タイミングを見計らった個別通知や,健診受診の意義を伝える勧奨を,集団および個人を対象に実施したことにより,高年層,中壮年層ともに健診受診率は大きく上昇し,本受診勧奨手法の有用性が示された。(著者抄録)

Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese: a 24-year follow-up of NIPPON DATA80.

Miyagawa N, Miura K, Okuda N, Kadowaki T, Takashima N, Nagasawa SY, Nakamura Y, Matsumura Y, Hozawa A, Fujiyoshi A, Hisamatsu T, Yoshita K, Sekikawa A, Ohkubo T, Abbott RD, Okamura T, Okayama A, Ueshima H, NIPPON DATA80 Research Group.

Atherosclerosis （ELSEVIER IRELAND LTD） 232 （ 2 ） 384 - 9 2014年02月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り, ISSN 0021-9150

Background: Dietary intake of long-chain n-3 PUFA (LCn3FA) among Japanese is generally higher than that in Western populations. However, little is known whether an inverse association of LCn3FA with cardiovascular disease (CVD) risk exists in a population with higher LCn3FA intake.
Objective: To investigate the association between LCn3FA intake and the long-term risk of CVDs in a Japanese general population.
Methods: We followed-up a total of 9190 individuals (56.2% women, mean age 50.0 years) randomly selected from 300 areas across Japan and free from CVDs at baseline. Dietary LCn3FA intake was estimated using household weighed food records. Cox models were used to calculate multivariate-adjusted hazard ratios (HR) and confidence intervals (CI) according to sex specific quartiles of LCn3FA intake.
Results: During 24-year follow-up (192,897 person-years), 879 cardiovascular deaths were observed. The median daily intake of LCn3FA was 0.37% kcal (0.86 g/day). Adjusted HR for CVD mortality was lower in the highest quartile of LCn3FA intake (HR 0.80; 95% CI 0.66-0.96) compared with the lowest quartile, and the trend was statistically significant (P = 0.038). The similar but statistically non-significant trends were observed for coronary heart disease death and stroke death. In analyses by age groups, the inverse associations of LCn3FA intake with the risk of total CVD death and stroke death were significant in younger individuals (30-59 years at baseline).
Conclusion: LCn3FA intake was inversely and independently associated the long-term risk of total CVD mortality in a representative sample of Japanese with high LCn3FA intake. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

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Impact of metabolic syndrome on the risk of cardiovascular disease mortality in the United States and in Japan.

Liu L, Miura K, Fujiyoshi A, Kadota A, Miyagawa N, Nakamura Y, Ohkubo T, Okayama A, Okamura T, Ueshima H

The American journal of cardiology （EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC） 113 （ 1 ） 84 - 9 2014年01月

研究論文（学術雑誌）, 査読有り, ISSN 0002-9149

The United States has a higher prevalence of metabolic syndrome (MS) and cardiovascular disease (CVD) mortality than Japan, but it is unknown how much of the difference in MS accounts for the mortality difference. The aim of this study was to examine the impact of MS on the excess CVD mortality in the United States compared with that in Japan. Data from the United States Third National Health and Nutrition Examination Survey (NHANES 111; n = 12,561) and the Japanese National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in Aged (NIPPON DATA; n = 7,453) were analyzed. MS was defined as of 5 risk factors (obesity, high blood pressure, decreased high-density lipoprotein cholesterol, elevated glycosylated hemoglobin, and elevated triglycerides). The results show that after a median of 13.8 years of follow-up in the United States, 1,683 patients died from CVD (11.75 per 1,000 person-years), and after a median of 15 years of follow-up in Japan, 369 patients died from CVD (3.56 per 1,000 person-years). The age-adjusted prevalence of MS was 26.7% in the United States and 19.3% in Japan. Of 5 MS factors, obesity, high blood pressure, elevated triglycerides, and glycosylated hemoglobin in the United States, and high blood pressure and elevated glycosylated hemoglobin in Japan were significant risk factors for CVD mortality. Estimates of 13.3% and 44% of the excess CVD mortality for the United States could be explained by the higher prevalence of MS and MS plus baseline CVD history than in Japan. In conclusion, the present study is the first to quantitatively demonstrate that MS and MS plus baseline CVD history may significantly contribute to the explanation of excess CVD mortality in the United States compared with Japan. (C) 2014 Elsevier Inc. All rights reserved.

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