Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

Ueshima, Hirotsugu

doi:10.5551/jat.e529

Cited by 249 publications

(238 citation statements)

References 46 publications

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“…Moreover, CAD incidence is significantly lower in Japan compared with that in the United States and Western countries (21), and Japan has two to five times lower CAD mortality than that in the United States and Europe (22).…”

Section: Discussionmentioning

confidence: 96%

Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort

Goto

Okada

Yamamoto

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Evidence regarding the differences in clinical outcomes after preemptive kidney transplantation (PKT) and non-PKT in Japan is lacking.Design, setting, participants, & measurements We conducted a retrospective cohort study at a single center in Japan. Consecutive patients ages .18 years old who had received a kidney transplant from a living donor between November of 2001 and December of 2013 at our institution (n=786) were enrolled. The primary study outcome was the occurrence of clinical events before the end of 2014. Clinical events were defined as any of the following: death with functioning graft (DWFG), graft loss, or post-transplant cardiovascular disease (CVD).Results The median follow-up period was 61.0 (35.3-94.0) months. PKT was performed in 239 patients (30.4%). Clinical events occurred in 78 (9.9%). In the Cox proportional hazard model for univariate analysis, factors found to be associated with higher risk of clinical events included older age, men, ABO incompatibility, longer dialysis duration, diabetes, pretransplant CVD, and large ventricular mass index. PKT was associated with lower risk. Clinical event rate in patients who received a PKT was 3.3% compared with 10.8%, 11.1%, 10.4%, 10.2%, 16.7%, and 16.2% among patients who were on dialysis for ,1, 1 to ,2, 2 to ,3, 3 to ,4, 4 to ,5, and $5 years before transplant, respectively (P=0.002). The multivariate analysis showed that ABO incompatibility (hazard ratio [HR], 2.98; 95% confidence interval [95% CI], 1.89 to 4.71), duration of dialysis per year (HR, 1.07; 95% CI, 1.03 to 1.11), and diabetes (HR, 3.54; 95% CI, 2.05 to 6.12) were only three independent risk factors for the incidence of clinical events.Conclusions Even in Japan, where the long-term outcomes of patients on hemodialysis are excellent, PKT could be beneficial to reduce DWFG, graft loss, and post-transplant CVD.

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Section: Discussionmentioning

confidence: 96%

Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort

Goto

Okada

Yamamoto

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…The mean level of blood pressure is higher in Japan than in Western countries, 17,35,[37][38][39][40][41] despite a substantial decline in blood pressure during the past four decades. 42 In addition, the prevalence of smoking among Japanese men remains much higher compared with men in the West, [8][9][10]17,35,37,41,43 although there has been a trend for a decline in smoking. 42 As a result, approximately 70-80% of Japanese men have hypertension and/or a smoking habit, 16,23 which would directly contribute to as much as 20% of the entire medical expenditures in this population.…”

Section: Discussionmentioning

confidence: 99%

“…42 In addition, the prevalence of smoking among Japanese men remains much higher compared with men in the West, [8][9][10]17,35,37,41,43 although there has been a trend for a decline in smoking. 42 As a result, approximately 70-80% of Japanese men have hypertension and/or a smoking habit, 16,23 which would directly contribute to as much as 20% of the entire medical expenditures in this population. Individuals with the coexistence of both these two risk factors comprise approximately 20-30% of the Japanese male population.…”

Section: Discussionmentioning

confidence: 99%

Medical expenditures of men with hypertension and/or a smoking habit: a 10-year follow-up study of National Health Insurance in Shiga, Japan

et al. 2010

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Hypertension and smoking are major causes of disability and death, especially in the Asia-Pacific region, where there is a high prevalence of a combination of these two risk factors. We attempted to measure the medical expenditures of a Japanese male population with hypertension and/or a smoking habit over a 10-year period of follow-up. A cohort study was conducted that investigated the medical expenditures due to a smoking habit and/or hypertension during the decade of the 1990s using existing data on physical status and medical expenditures. The participants included 1708 community-dwelling Japanese men, aged 40-69 years, who were classified into the following four categories: 'neither smoking habit nor hypertension', 'smoking habit alone', 'hypertension alone' or 'both smoking habit and hypertension.' Hypertension was defined as a systolic blood pressure of X140 mm Hg, a diastolic blood pressure of X90 mm Hg or taking antihypertensive medications. In the study cohort, 24.9% had both a smoking habit and hypertension. During the 10-year follow-up period, participants with a smoking habit alone (18 444 Japanese yen per month), those with hypertension alone (21 252 yen per month) and those with both a smoking habit and hypertension (31 037 yen per month) had increased personal medical expenditures compared with those without a smoking habit and hypertension (17 418 yen per month). Similar differences were observed even after adjustment for other confounding factors (Po0.01). Japanese men with both a smoking habit and hypertension incurred higher medical expenditures compared with those without a smoking habit, hypertension or their combination.

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“…3 Although the prevalence of overweight in Japanese men is increasing, 5 the mean systolic and diastolic blood pressures are declining. 6,7 Thus, an increase in prevalence of obesity due to less physical activity alone may not provide the cause of this change. We need further studies to clarify this point.…”

Section: Yasuyuki Nakamuramentioning

confidence: 99%

Modernization, less physical activity, more obesity and hypertension

Nakamura¹

2010

Hypertens Res

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I n this issue, Yang et al. 1 reported change in the prevalence of prehypertension and hypertension in Shangdong Province, a rural area in the east of China, from 1991 to 2007. The authors performed three surveys regarding blood pressure and lifestyles in large population samples aged 35-74 years. The prevalence of hypertension showed a steady increase from 20.4 to 30.6%. As the age range was fixed, the reasons for an increase in hypertension prevalence may be one or more of the following: increase in alcohol and/or salt consumption, increase in prevalence of overweight and obesity, less physical activity or less treatment. As a decline in alcohol intake and increase in hypertension awareness, treatment and control were shown, we may be able to rule out some of the above possibilities. The prevalence of overweight (body mass index between 25 and 30 kg m À2 ) increased from 19.7 to 49.7%, and that of obesity (body mass index X30 kg m À2 ) increased from 3.5 to 9.3%, paralleled with a decline in work-related high-strength physical activity from 75.5 to 49.5%; the authors suggested that these factors contributed to an increase in prevalence of hypertension.However, the important information lacking in this study is that relating to salt intake. Several studies have shown that blood pressure levels and hypertension prevalence in the northern part of China are higher than those in the southern part of China. [2][3][4] This difference is explained in part by the difference in salt consumption. 3 Although the prevalence of overweight in Japanese men is increasing, 5 the mean systolic and diastolic blood pressures are declining. 6,7 Thus, an increase in prevalence of obesity due to less physical activity alone may not provide the cause of this change. We need further studies to clarify this point.

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Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

Cited by 249 publications

References 46 publications

Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort

Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort

Medical expenditures of men with hypertension and/or a smoking habit: a 10-year follow-up study of National Health Insurance in Shiga, Japan

Modernization, less physical activity, more obesity and hypertension

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