Objectives To determine whether severity of obstructive sleep apnea is associated with incident diabetes in middle-aged and older adults. Methods A prospective analysis of 1,453 non-diabetic participants of both the Atherosclerosis Risk in Communities Study and the Sleep Heart Health Study (mean age 63 years, 46% male) had in-home polysomnography (1996–1998) and were followed for incident diabetes. Using the apnea-hypopnea index derived from home polysomnography, study participants were categorized as follows: <5.0 (normal), 5.0–14.9 (mild), 15.0–29.9 (moderate), and ≥30.0 events/h (severe). Incident diabetes was ascertained during annual follow-up telephone calls through 2013. Results During a median follow-up of 13 years, there were 285 incident diabetes cases among the 1453 participants. Participants with severe obstructive sleep apnea were at greater risk of incident diabetes compared to persons classified as normal after adjustment for confounders including body mass index and waist circumference (1.71 [1.08, 2.71]). The association between severe obstructive sleep apnea and incident diabetes was similar when analyses were restricted to obese individuals. Conclusions Severe obstructive sleep apnea was associated with greater risk of incident diabetes, independent of adiposity in a community-based sample. Healthcare professionals should be cognizant of the high prevalence of OSA in the general population and the potential link to incident diabetes.

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Platelets and circulating CD34-positive cells have been reported to contribute to vascular repair (endothelial repair and developing atherosclerosis). And because hypertension is known to be a strong vascular impairment factors, it should also influence the respective numbers of these factors. To clarify the clinical importance of platelets on vascular repair, we conducted a cross-sectional study of 567 Japanese men aged 60-69 who underwent an annual health check-up between 2013 and 2015. Multiple linear regression analysis of non-hypertensive subjects adjusting for classical cardiovascular risk factors showed that although platelet count did not significantly correlate with carotid intima media thickness (β = −0.05, p = 0.356), it did positively correlate significantly with the natural log of the number of circulating CD34-positive cells (β = 0.26, p < 0.001). In hypertensive subjects, a significant positive correlation was seen between platelets and intima media thickness (β = 0.19, p = 0.008), whereas no significant correlation was seen between platelet count and the natural log of the number of circulating CD34-positive cells (β = 0.11, p = 0.119). Our results indicate that platelet count is an indicator of vascular repair activity (endothelial repair and developing atherosclerosis). Additionally, hypertension might mask the beneficial effects of circulating CD34-positive cells.

Background We tested whether objectively measured indices of obstructive sleep apnea (OSA) and sleep quality are associated with coronary artery calcification (CAC) prevalence independent of obesity, a classic confounder. Methods A total of 1,465 Multi-Ethnic Study of Atherosclerosis participants [mean age 68 years], who were free of clinical cardiovascular disease, had both coronary CT and in-home polysomnography and actigraphy. OSA categories were defined by apnea-hypopnea index (AHI). Prevalence ratios for CAC >0 and >400 (high burden) were calculated. Results Participants with severe OSA (AHI ≥ 30; 14.6%) were more likely to have prevalent CAC, relative to those with no evidence of OSA, after adjustment for demographics and smoking status [1.16 (95% CI: 1.06–1.26)], body mass index [1.11 (1.02–1.21)], and traditional cardiovascular risk factors [1.10 (1.01–1.19)]. Other markers of hypoxemia tended to be associated with higher prevalence of CAC >0. For CAC >400 a higher prevalence was observed with both a higher arousal index and less slow-wave sleep. Overall, associations were somewhat stronger among younger participants, but did not vary by sex or race/ethnicity. Conclusions In this population-based multiethnic sample severe OSA was associated with subclinical coronary artery disease (CAC >0), independent of obesity and traditional cardiovascular risk factors. Furthermore, the associations of the arousal index and slow wave sleep with high CAC burden suggest that higher nightly sympathetic nervous system activation is also a risk factor. These findings highlight the potential importance in measuring disturbances in OSA as well as in sleep fragmentation as possible risk factors for coronary artery disease.

Background and Purpose Having a small social network and lack of social support have been associated with incident coronary heart disease, however epidemiologic evidence for incident stroke is limited. We assessed the longitudinal association of a small social network and lack of social support with risk of incident stroke, and evaluated whether the association was partly mediated by vital exhaustion and inflammation. Methods The Atherosclerosis Risk in Communities (ARIC) Study measured social network and social support in 13,686 men and women (mean, 57±5.7 years, 56% female, 24% black; 76% white) without a history of stroke. Social network was assessed by the 10-item Lubben Social Network Scale, and social support by a 16-item Interpersonal Support Evaluation List-Short Form (ISEL-SF). Results Over a median follow-up of 18.6-years, 905 incident strokes occurred. Relative to participants with a large social network, those with a small social network had a higher risk of stroke [HR (95% CI): 1.44 (1.02–2.04)] after adjustment for demographics, socioeconomic variables and marital status, behavioral risk factors and major stroke risk factors. Vital exhaustion, but not inflammation, partly mediated the association between a small social network and incident stroke. Social support was unrelated to incident stroke. Conclusions In this sample of US community-dwelling men and women, having a small social network was associated with excess risk of incident stroke. As with other cardiovascular conditions, having a small social network may be associated with a modestly increased risk of incident stroke.

Age-related disruption of microvascular endothelium exacerbates hypertension and sarcopenia; and atherosclerosis is a well-known biological response to vascular endothelial injury. Therefore, prevalence of atherosclerosis among hypertensive elderly subjects may partly indicate the presence of an appropriate response to endothelial injury. We conducted a cross-sectional study of 795 elderly hypertensive Japanese subjects aged 60-89 years. Since platelet level is an indicator of vascular repair activity, subjects were stratified by platelet counts. No significant association between handgrip strength and subclinical carotid atherosclerosis (carotid intima-media thickness (CIMT) ≥1.1mm) was observed for subjects with lower platelet counts, while a significant positive association was observed for subjects with higher platelets. Adjusted odds and 95% confidence intervals of subclinical carotid atherosclerosis for 1 standard deviation increments in handgrip strength were 0.86 (0.61, 1.22) for subjects with lower platelets and 1.82 (1.26, 2.64) for subjects with higher platelets. A positive association between handgrip strength and subclinical carotid atherosclerosis exists in hypertensive elderly subjects with higher, but not lower, platelet counts. These results lead us to speculate that subjects with a beneficial influence on prevention of sarcopenia (maintenance of handgrip strength) may possess the capacity of active endothelial repair that causes atherosclerosis.

Background: The Japan Multi-institutional Collaborative Cohort (J-MICC) study was launched in 2005 to examine gene-environment interactions in lifestyle-related diseases, including cancers, among the Japanese. This report describes the study design and baseline profile of the study participants. Methods: The participants of the J-MICC Study were individuals aged 35 to 69 years enrolled from respondents to study announcements in specified regions, inhabitants attending health checkup examinations provided by local governments, visitors at health checkup centers, and first-visit patients at a cancer hospital in Japan. At the time of the baseline survey, from 2005 to 2014, we obtained comprehensive information regarding demographics, education, alcohol consumption, smoking, sleeping, exercise, food intake frequency, medication and supplement use, personal and family disease history, psychological stress, and female reproductive history and collected peripheral blood samples.

Aim: The cardio-ankle vascular index (CAVI) reflects functional arterial stiffness, which is related to endothelial dysfunction. CD34-positive cells carry out an important function in endothelial repair. However, there have been no reports assessing the association between CAVI and the number of circulating CD34-positive cells.Methods: We carried out a cross-sectional study of 249 Japanese men, aged 60-69 years, who underwent annual health checkups between 2013 and 2015. As individuals with high levels of circulating CD34-positive cells might indicate the influence of consumptive reduction of circulating CD34-positive cells as a result of aggressive endothelial repair, participants were stratified by circulating CD34-positive cell levels, using the median value in this population (0.95 cells/μL) as the cut-off.Results: For participants with low circulating CD34-positive cell levels, logarithmic values of circulating CD34-positive cells were inversely associated with CAVI (multivariable standardized parameter estimate [β] = −0.22, P = 0.014), but not for participants with high levels (β = −0.04, P = 0.638). In addition, even when no significant associations between CAVI and carotid intima-media thickness were detected for participants with low circulating CD34-positive cell levels (β = −0.02, P = 0.865), significant positive associations were identified for participants with high levels (β = 0.22, P = 0.028). Conclusions:As circulating CD34-positive cell count might indicate endothelial repair activity, the present results show that CAVI is affected by insufficient endothelial repair in individuals with low circulating CD34-positive cell counts. Our results also show that a positive association between CAVI and carotid intima-media thickness exists only in individuals with aggressive endothelial repair, which indicates the presence of organic arterial disease, such as atherosclerosis.