Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California

Robertson, Thomas; Kato, Hiroo; Gordon, Tavia; Kagan, Abraham; Rhoads, George G.; Land, Charles E.; Worth, Robert M.; Belsky, Joseph L.; Dock, Donald S.; Miyanishi, Michihiro; Kawamoto, Shoichi

doi:10.1016/s0002-9149(77)80198-7

Cited by 217 publications

(79 citation statements)

References 19 publications

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“…To reduce the economic burden, non-pharmacological therapy of mild hypertension should be promoted, since the overall impact of mild hypertension is much less severe (14). In Okinawa, the incidence of stroke appears to be lower than that in other parts of Japan (15,16), but it is still higher than that in the United States (17,18). The incidence of AMI is lower in Okinawa than in other parts of Japan (19) and much lower than that reported by the Framingham study (20).…”

Section: Discussionmentioning

confidence: 87%

Comparison of the Effect of Blood Pressure on the Development of Stroke, Acute Myocardial Infarction, and End-Stage Renal Disease.

et al. 2000

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Hypertension is a known risk factor for cardiovascular disease, but few epidemiological studies have examined simultaneously the effect of baseline blood pressure on the development of stroke, acute myocardial infarction (AMI), and end-stage renal disease (ESRD). In 1983, a large, community-based mass screening covered about 14% of the adult population in Okinawa, Japan. The total number of people screened was 107,192 (51,122 men, 56,070 women). We had access to two independent registries of end-organ damage: the Co-operative Study Group of Morbidity and Mortality of Cardiovascular Diseases in Okinawa (COSMO) registry for stroke and AMI, and the Okinawa Dialysis Study (OKIDS) registry for ESRD. The total number of people registered was 4,756 with stroke, 1,059 with AMI, and 641 with ESRD during the study period from April 1, 1988, to March 31, 1991. By using the name, sex, birth date, and ZIP code of registrants, we identified those registrants who were screened in 1983 and had developed stroke, AMI, or ESRD. Hypertension was defined as systolic blood pressure (SBP) of 140 mmHg or higher or diastolic blood pressure (DBP) of 90 mmHg or higher. Other readings were regarded as normotensive. The prevalence of hypertension was 35.8% (N= 37,299). The cumulative incidence of stroke, AMI, and ESRD was 154, 21, and 19 subjects among those with SBP 119 mmHg, and 1933, 315, and 71 subjects among those with SBP >_ 160 mmHg. Similarly, the incidence of stroke, AMI, and ESRD was 234, 44, and 25 subjects among those with DBP 69 mmHg and 1980, 381, and 364 subjects among those with DBP? 110 mmHg.Hypertension was prevalent in the adult population in Okinawa, Japan, and was a significant predictor of stroke, AMI, and ESRD. However, the effect of blood pressure on target organs differed and was more evident in those with stroke than in those with AMI and ESRD. (Hypertens Res 2000; 23:143-149) Key Words: hypertension, mass screening, stroke, acute myocardial infarction, end-stage renal disease IntroductionThe Japanese are living longer than ever before (1), especially people in Okinawa, and the death rate from stroke has dropped dramatically in the past 30 years (2). This decline is partly explained by the national policy of decreasing salt intake and increasing public health education. The average salt intake remains around 12 g per d.Because of the rapidly increasing number of aging people, concerns about high blood pressure are increasing. The incidence of cardiovascular diseases differs among ethnic groups (3), however, so clinical guidelines should be based on epidemiological evidence from a given community (4). Only a few studies have examined the determinants of hypertension in a large, community-based popu- Vol. 23, No. 2 (2000) lation. Moreover, few epidemiological studies have examined simultaneously the effect of baseline blood pressure on the development of stroke, myocardial infarction (AMI), and end-stage renal disease (ESRD). Our study documented the prevalence of hypertension and analyzed the risk factors for...

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Section: Discussionmentioning

confidence: 87%

Comparison of the Effect of Blood Pressure on the Development of Stroke, Acute Myocardial Infarction, and End-Stage Renal Disease.

et al. 2000

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“…The Ni-Hon-San study (18)(19)(20), involving Japanese men living in Japan (Hiroshima, Nagasaki), Hawaii and California, showed a gradient increase in the prevalence and mortality of IHD from Japan to Hawaii and to California corresponding to the increase in cholesterol level that accompanied an increasing intake of animal protein and saturated fat. Tsugane (21) and Gotlieb (23) demonstrated that the mortality rates for diabetes mellitus (DM) and IHD in first-generation Japanese immigrants in Sao Paulo, Brazil, were approximately twice as high as in Japanese in Japan but only about half that in the general population of Sao Paulo, and that the mortality rate for stroke in Japanese immigrants was less than that of either Japanese in Japan or the population of Sao Paulo.…”

Section: Discussionmentioning

confidence: 99%

“…To verify causal relationships between CVD and risk factors, taking into account interactions between genetic and environmental factors, studies of immigrant populations are likely to be particularly useful (17). Studies on Japanese immigrants in the United States (18)(19)(20) and South America (21)(22)(23), have provided key evidence on these relationships. Japan has remarkably prolonged average life expectancy to the highest in the world (1, 2) (75.86 and 81.81 years, men and women, respectively, as of 1990), having greatly reduced mortality from infectious diseases and stroke during the past 40 years; there has also been a great improvement in nutritional conditions, including increases in protein and fat intake up to optimal level, during this period (24)(25)(26)(27)(28).…”

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confidence: 99%

The Relationship of Dietary Factors to Cardiovascular Diseases among Japanese in Okinawa and Japanese Immigrants, Originally from Okinawa, in Brazil.

et al. 1992

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To investigate the relationship of dietary factors to cardiovascular diseases, we conducted a study of 234 middle-aged Japanese men and women in Okinawa (JJ), and 160 Japanese immigrants of similar age, originally from Okinawa, in Brazil (JB). JB showed double the prevalence (%) of ST-T changes in the electrocardiogram (ECG) (JJ: M3.4, F4.4, JB: M8.3, F10.1) and of hypertension (HT) (JJ: M15.9, F18.4; JB: M32.8, F36.4, p < 0.05) when this was assessed on BP> 160195 and/or the taking of antihypertensive medication; however the mean level of blood pressure did not differ. A gradient in the rate of HT in men and of ECG ST-T changes in both sexes was observed from JJ to JB of first-generation and to JB of second-generation. JB had much higher body mass index (kg/m2) (JJ: M24.8 ± 0.3, F24.8 ± 0.4; JB:M26.2 ± 0.4, F26.5±0.4, p < 0.01) in both sexes, and an 8-fold higher rate of oral contraceptive usage (p < 0.001). Total cholesterol level showed no significant difference between JJ and JB. 24-hour urinary taurine excretion in both sexes and plasma phospholipid n-3 fatty acid level in men were significantly higher in JJ than in JB. The dietary pattern in Japanese immigrants in Brazil, characterized by low fish and large meat intake, is possibly responsible for the higher risk of HT and ECG ST-T changes, indicating the importance of dietary rather than genetic factors. (Hypertens Res 1992;15: 45-55)

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“…33 This difference can be roughly explained by the differences in serum cholesterol and adiposity. 11 Triglyceride levels are also higher in Hawaii than in Japan, but since they have not been shown to be an independent risk factor in either setting, there is little reason to invoke an explanatory role for them. A clear excess.of men with triglycerides above 315 mg/dl is found in Honolulu as opposed to Framingham, and yet the CHD rates are twofold higher in the Massachusetts groups.…”

Section: Discussionmentioning

confidence: 99%

Serum triglyceride and risk of coronary heart disease, stroke, and total mortality in Japanese-American men.

Rhoads

Feinleib

1983

Arteriosclerosis

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The role of serum triglyceride as a risk factor for coronary heart disease (CHD), stroke, and total mortality was examined in men of Japanese ancestry who were 45 to 78 years old. During the first 10 years following a baseline nonfasting triglyceride determination, there were 490 incidence cases of CHD in 7615 men at risk. Average annual incidence rates were 2.1 times higher in men with nonfasting values above the 75th percentile (279 mg/dl) than in those under the 25th percentile (129 mg/dl, p < 0.001). This association largely disappeared when associations of triglyceride with other CHD risk factors were accounted for.Fasting triglycerides were measured in a representative sample of 1729 men partway through the study. With an average follow-up of 5.7 years there were 72 new CHD cases in this group with the risk for men in the top quartile (above 195 mg/dl) being 1.9 times higher than for those in the bottom quartile (below 94 mg/dl). This gradient was of borderline significance (p < 0.10) and completely disappeared in a multivariate analysis which included HDL and other factors. It appears that the association of triglyceride with CHD in this cohort is of a noncausal nature. Triglycerides were not predictive of stroke or of total mortality in these men. (Arteriosclerosis 3:316-322, July/August 1983) E arly case-control studies identified serum triglyceride as a potential risk factor for coronary heart disease (CHD). 1 " 4 Since it was a major constituent of the lipoproteins and was found in atherosclerotic plaque, 5 there was reason to suspect that these findings had causal implications, and primary hypertriglyceridemia has subsequently received considerable attention.Over the past two decades a number of prospective studies have focused on the role of triglycerides as risk factors. 6 " 12 In most of these, triglycerides were positively related to CHD, but in multivariate logistic regressions the associations appeared to be explained by other variables, especially age, obesity, high density lipoprotein (HDL) and low density lipoprotein (LDL). The implication is that hypertriglyceridemic persons tend to have other characteristics which put them at risk for CHD, but that the triglycerides per se have little effect on risk. Thus, Hulley et al. 13 recommended "that widespread screening and treatment of healthy persons for hypertriglyceridemia be abandoned." In this paper we present further epidemiological evidence on the association of triglycerides with atherosclerotic diseases based on a large data set collected prospectively among Japanese-American men in Honolulu. Attention is focused on comparative findings for fasting and nonfasting triglycerides and on the effect of reproducibility of measurement in interpreting the results.

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Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California

Cited by 217 publications

References 19 publications

Comparison of the Effect of Blood Pressure on the Development of Stroke, Acute Myocardial Infarction, and End-Stage Renal Disease.

Comparison of the Effect of Blood Pressure on the Development of Stroke, Acute Myocardial Infarction, and End-Stage Renal Disease.

The Relationship of Dietary Factors to Cardiovascular Diseases among Japanese in Okinawa and Japanese Immigrants, Originally from Okinawa, in Brazil.

Serum triglyceride and risk of coronary heart disease, stroke, and total mortality in Japanese-American men.

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