Cardiovascular disease (CVD) is the leading cause of death in the world and half of the cases of CVD are estimated to occur in Asia. Compared with Western countries, most Asian countries, except for ...Japan, South Korea, Singapore and Thailand, have higher age-adjusted mortality from CVD. In Japan, the mortality from CVD, especially stroke, has declined continuously from the 1960s to the 2000s, which has contributed to making Japan into the top-ranking country for longevity in the world. Hypertension and smoking are the most notable risk factors for stroke and coronary artery disease, whereas dyslipidemia and diabetes mellitus are risk factors for ischemic heart disease and ischemic stroke. The nationwide approach to hypertension prevention and control has contributed to a substantial decline in stroke mortality in Japan. Recent antismoking campaigns have contributed to a decline in the smoking rate among men. Conversely, the prevalence of dyslipidemia and diabetes mellitus increased from the 1980s to the 2000s and, therefore, the population-attributable risks of CVD for dyslipidemia and diabetes mellitus have increased moderately. To prevent future CVD in Asia, the intensive prevention programs for hypertension and smoking should be continued and that for emerging metabolic risk factors should be intensified in Japan. The successful intervention programs in Japan can be applied to other Asian countries. (Circ J 2013; 77: 1646–1652)
Background: While laughter is broadly recognized as a good medicine, a potential preventive effect of laughter on disability and death is still being debated. Accordingly, we investigated the ...association between the frequency of laughter and onset of functional disability and all-cause mortality among the older adults in Japan. Methods: The data for a 3-year follow-up cohort including 14,233 individuals (50.3% men) aged ≥65 years who could independently perform the activities of daily living and participated in the Japan Gerontological Evaluation Study were analyzed. The participants were classified into four categories according to their frequency of laughter (almost every day, 1–5 days/week, 1–3 days/month, and never or almost never). We estimated the risks of functional disability and all-cause mortality in each category using a Cox proportional hazards model. Results: During follow-up, 605 (4.3%) individuals developed functional disability, identified by new certification for the requirement of Long-Term Care Insurance, and 659 (4.6%) deaths were noted. After adjusting for the potential confounders, the multivariate-adjusted hazard ratio of functional disability increased with a decrease in the frequency of laughter (P for trend = 0.04). The risk of functional disability was 1.42 times higher for individuals who laughed never or almost never than for those who laughed almost every day. No such association was observed with the risk of all-cause mortality (P for trend = 0.39). Conclusions: Low frequency of laughter is associated with increased risks of functional disability. Laughter may be an early predictor of functional disability later on in life.
Aim: Seaweed contains soluble dietary fibers, potassium, and flavonoids and was recently reported to be inversely associated with the risk of coronary heart disease and mortality from stroke. ...However, epidemiological evidence on this issue has remained scarce. Methods: At the baseline survey of four Japanese communities between 1984 and 2000, we enrolled 6,169 men and women aged 40–79 years who had no history of cardiovascular disease. We assessed their seaweed intake using the data from a 24 h dietary recall survey and categorized the intake into four groups (0, 1–5.5, 5.5–15, and ≥ 15 g/day). We used sex-specific Cox proportional hazards models to examine the association between seaweed intake and risk of cardiovascular disease (stroke, stroke subtypes, and coronary heart disease). Results: During the 130,248 person-year follow-up, 523 cases of cardiovascular disease occurred: 369 cases of stroke and 154 cases of coronary heart disease. Seaweed intake levels were inversely associated with the risk of total stroke and cerebral infarction among men but not among women. Adjustment for cardiovascular risk factors did not change the associations: the hazard ratios (95% confidence intervals; P for trend) for the highest versus lowest categories of seaweed intake were 0.63 (0.42–0.94; 0.01) for total stroke and 0.59 (0.36–0.97; 0.03) for cerebral infarction. No associations were observed between seaweed intake and risks of intraparenchymal hemorrhage, subarachnoid hemorrhage, or coronary heart disease among men or women. Conclusions: We found an inverse association between seaweed intake and risk of total stroke, especially that from cerebral infarction, among Japanese men.
Background:Few studies have investigated the association between serum albumin levels and the risk of stroke subtypes among the general Japanese population.Methods and Results:In this study, 5,071 ...men and 7,969 women aged 40–74 years, initially free from stroke, coronary artery disease, and kidney and hepatic failure, and residing in 4 Japanese communities completed a baseline risk factor survey between 1985 and 1994. During the 24-year follow-up, 528 men and 553 women experienced stroke. In the entire study cohort, multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) of total stroke, ischemic stroke, and intracerebral hemorrhage for the lowest vs. highest quartiles of serum albumin were 1.45 (1.18–1.77), 1.52 (1.17–1.97), and 1.57 (1.04–2.37), respectively. In men, multivariable HRs (95% CIs) for total stroke, ischemic stroke, and intracerebral hemorrhage in the lowest vs. highest serum albumin quartile were 1.44 (1.07–1.92), 1.48 (1.03–2.11) and 1.71 (0.92–3.18), respectively, whereas in women they were 1.50 (1.13–1.99), 1.63 (1.11–2.39), and 1.56 (0.89–2.74), respectively. Similar inverse associations were observed for each of the ischemic stroke subtypes, but not for subarachnoid hemorrhage.Conclusions:Low serum albumin levels were associated with an increased risk of total stroke, ischemic stroke, ischemic stroke subtypes, and intracerebral hemorrhage.
Aim: This study aimed to investigate the associations of leukocyte count with the risks of stroke and coronary heart disease among the general Japanese population. Methods: A total of 5,242 residents ...aged 40–69 years living in two Japanese communities underwent leukocyte count measurements between 1991 and 2000, and the data were updated using 5- or 10-year follow-ups or both. Participants who had histories of stroke, coronary heart disease, or high values of leukocyte count (＞130×102 cells/mm3) were excluded. Hazard ratios with 95% confidence intervals (CIs) were calculated according to quartiles of cumulative average leukocyte count. Results: During follow-up of 21 years, 327 stroke and 130 coronary heart disease cases were determined. After adjustments for age, sex, community, and updated cardiovascular risk factors, the multivariable hazard ratio (95% CI) for the highest versus lowest quartile of leukocyte count was 1.50 (1.08–2.08) for ischemic stroke, 1.59 (1.00–2.51) for lacunar infarction, 1.42 (0.90–2.26) for non-lacunar infarction, 2.17 (1.33–3.55) for coronary heart disease, and 1.40 (1.11–1.76) for total cardiovascular disease. In smoking status-stratified analyses, the corresponding multivariable hazard ratio (95% CI) was 2.45 (1.11–5.38) for ischemic stroke, 2.73 (1.37–5.44) for coronary heart disease in current smokers, 2.42 (1.07–5.46), 1.55 (0.58–4.15) in former smokers, and 1.17 (0.75–1.82), 1.78 (0.83–3.82) in never smokers. Conclusion: Leukocyte count was positively associated with the risks of ischemic stroke and coronary heart disease among the general Japanese population, especially in current smokers.
Aim: We aimed to examine the impact of high-risk levels of cardiovascular risk factors on the incidence of cardiovascular disease (CVD) in overweight and non-overweight individuals without treatment ...for the risk factors. Methods: A total of 8,051 individuals aged 40–74 years without a history of CVD and/or without treatment for hypertension, diabetes, hyperlipidemia, and kidney disease at baseline in 1995–2000 were followed up for a median of 14.1 years. We classified the participants into three risk categories (low-, intermediate-, and high-risk groups) on the basis of individual risk factors (blood pressure, serum glucose, low-density lipoprotein cholesterol LDL-C, and urinary protein) according to the guidelines of Japanese clinical societies. The high-risk group (systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 100 mmHg, fasting serum glucose ≥ 130 mg/dL or non-fasting serum glucose ≥ 180 mg/dL, LDL-C ≥ 180 mg/dL, proteinuria ≥ 2+) needed to refer to physicians or start treatment immediately. Overweight was defined as a body mass index of ≥ 25 kg/m2. Results: Compared with those in the non-overweight low-risk group, the hazard ratios (HRs) (95% confidence intervals, population-attributable fractions PAFs) of CVD in the high-risk categories of blood pressure were 2.0 (1.4–2.9, 7.0%) in the non-overweight high-risk group and 2.9 (1.9–4.3, 6.8%) in the overweight high-risk group. The corresponding HRs (95% confidence intervals, PAFs) of serum glucose were 2.0 (1.2–3.4, 2.5%) and 2.2 (1.1–4.3, 1.5%) in the non-overweight and overweight high-risk groups, respectively. Such associations were not observed for the high-risk group of LDL-C and proteinuria. Conclusions: The present long-term observational study implies that targeting persons with non-treated severe hypertension and diabetes is prioritized to prevent CVD regardless of overweight status.
To assess relationships between the perception of radiation risks and psychological distress among evacuees from the Fukushima nuclear power plant disaster.
We analysed cross-sectional data from a ...survey of evacuees conducted in 2012. Psychological distress was classified as present or absent based on the K6 scale. Respondents recorded their views about the health risks of exposure to ionizing radiation, including immediate, delayed and genetic (inherited) health effects, on a four-point Likert scale. We examined associations between psychological distress and risk perception in logistic regression models. Age, gender, educational attainment, history of mental illness and the consequences of the disaster for employment and living conditions were potential confounders.
Out of the 180,604 people who received the questionnaire, we included 59,807 responses in our sample. There were 8717 respondents reporting psychological distress. Respondents who believed that radiation exposure was very likely to cause health effects were significantly more likely to be psychologically distressed than other respondents: odds ratio (OR) 1.64 (99.9% confidence interval, CI: 1.42-1.89) for immediate effects; OR: 1.48 (99.9% CI: 1.32-1.67) for delayed effects and OR: 2.17 (99.9% CI: 1.94-2.42) for genetic (inherited) effects. Similar results were obtained after controlling for individual characteristics and disaster-related stressors.
Among evacuees of the Fukushima nuclear disaster, concern about radiation risks was associated with psychological distress.
See article vol. 23: 176-195 Currently, heart disease and stroke are the second and fourth leading causes of death in Japan, respectively, and remain the leading causes of death worldwide. In Western ...countries, risk prediction equations, such as the Framingham risk score (FRS) and the Systematic Coronary Risk Evaluation (SCORE), derived from epidemiologic cohort studies have been widely used in the primary prevention of cardiovascular disease (CVD). Furthermore, the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for the assessment of cardiovascular risk and the European guidelines on cardiovascular disease prevention applied these risk prediction equations to prevent CVD. Because these risk prediction equations were applicable to Caucasians, other risk prediction tools for Japanese have been also developed in recent years to identify individuals at high risk of CVD in Japan.
The Fukushima Health Management Survey (FHMS) was established in response to the Fukushima Daiichi Nuclear Power Plant accident on March 11, 2011. The primary objectives of the study are to monitor ...residents’ long-term health and promote their future well-being, and to determine the health effects of long-term low-dose radiation exposure. This special issue summarizes the results and current status of the FHMS and discusses the challenges and future directions of the FHMS. The FHMS, a cohort study of all people who were residents in Fukushima Prefecture at the time of the accident, consists of a Basic Survey, Thyroid Ultrasound Examination, Comprehensive Health Check, Mental Health and Lifestyle Survey, and Pregnancy and Birth Survey. The radiation exposure was estimated based on the behavioral records examined using the Basic Survey. Although the response rate was low in the Basic Survey, the representativeness of the radiation exposure data was confirmed using additional surveys. There appears to be no relationship between the radiation exposure and risk of thyroid cancer, although more thyroid cancer cases were detected than initially expected. The ongoing Comprehensive Health Check and Mental Health and Lifestyle Survey have provided evidence of worsening physical and mental health status. The Pregnancy and Birth Survey showed rates of preterm delivery, low birth weight, and congenital abnormalities similar to the national average. Considering the above evidence, the Fukushima Prefectural Government decided to end the Pregnancy and Birth Survey at the end of March 2021, as recommended by the Prefectural Oversight Committee. The framework of the FHMS has not changed, but the FHMS needs to adapt according to the survey results and the changing needs of the eligible residents and municipalities.
PDF
