Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels　― The Circulatory Risk in Communities Study (CIRCS) ―

Abstract

on behalf of the CIRCS InvestigatorsBackground: In Japan, a community-based screening program for cardiovascular disease (CVD) has been effective in preventing stroke and coronary artery disease (CAD). The present study aimed to clarify which risk factors assessed at the screening examinations affect the incidence of CVD and the magnitude of the association after the late 1990 s. Methods and Results:We conducted a 12.5-year prospective study of 10,612 Japanese residents aged 40-74 years between 1995 and 2000, initially free of CVD and who underwent the screening examinations. During the follow-up, 364 cases of stroke and 137 cases of CAD were identified. The population attributable fraction of stroke was the largest for hypertension (HT; 46%), while the relative risk of stroke was the highest for atrial fibrillation (multivariable hazard ratio, 4.9; 95% confidence interval, 2.9-8.3). The population attributable fraction of CAD was relatively large for HT, current smoking, and high non-high-density lipoprotein cholesterol (20-29%). A dose-response relationship was found between the incidence of these cardiovascular events and the number of comorbid hypertensive subclinical organ damage markers: funduscopic changes, ST-T changes on ECG at rest, proteinuria and low estimated glomerular filtration rate.Conclusions: HT and hypertensive subclinical organ damage are significantly associated with incident stroke and CAD at the population level, suggesting that management of HT and assessment of subclinical organ damage in hypertensive subjects at a screening program are still beneficial for community-based CVD prevention.

The Circulatory Risk in Communities Study (CIRCS): A Long-Term Epidemiological Study for Lifestyle-Related Disease Among Japanese Men and Women Living in Communities

“…CIRCS has led to the identification of several novel risk/preventive factors for CVD: lipids (eg, serum fatty acids composition 26 , 27 and high-density lipoprotein (HDL)-cholesterol particle size 28 ), glucose tolerance (non-fasting blood glucose 29 , 30 ), other biochemical factors (serum liver/biliary tract enzymes, 31 , 32 serum homocysteine, 33 serum C-reactive protein, 34 and adiponectins 35 ), hematological factors (leukocyte counts 36 ), fibrinolytic factors (plasma fibrinogen 37 – 39 ), electrocardiographic factors (ischemic abnormalities 40 , 41 and Brugada-type electrocardiogram 42 ), other physiological factors (carotid atherosclerosis 43 and ankle-brachial blood pressure index 44 ), dietary factors (fat and protein intakes 45 ), psychosomatic factors (depressive symptoms 46 ), height, 47 snoring, 48 metabolic syndrome, 49 , 50 chronic kidney disease, 51 and subclinical end-organ damage, 52 as well as traditional risk factors (eg, alcohol, 53 – 55 smoking, 56 blood glucose/diabetes, 57 , 58 blood pressure, 1 , 5 , 11 , 59 total-, 1 , 5 , 11 LDL-, 60 non-HDL- 61 and HDL-cholesterols, 62 , 63 and triglycerides 64 , 65 ). Recent reports included risk or preventive factors for dementia, such as smoking, 66 C-reactive protein, 67 serum coenzyme Q10, 68 serum α-linoleic acid, 69 and retinal vascular changes.…”

Controversies in the 2017 ACC/AHA Hypertension Guidelines: Who Can Be Eligible for Treatments Under the New Guidelines? ― An Asian Perspective ―

“…In addition, the relationship between BP levels and stoke incidence is stronger in Asian populations and the slope of association between BP levels and CVD events has also been shown to be steeper in Asian compared with Western populations. 6,[36][37][38] With respect to lifestyle interventions, reduction of salt intake is important. However, the estimated daily intake of Koran population according to KNHANES is approximately 12 g, which is higher than the recommendation of WHO (<6 g).…”

Short stature-related single-nucleotide polymorphism (SNP) activates endothelial repair activity in elderly Japanese

“…Hypertension is known as a major risk factor of stroke for Japanese [1] while short stature is well known as a Japanese characteristic. Furthermore, short stature has been reported to have an independent association with hypertension [2], carotid atherosclerosis [3], and incidence of stroke [4].…”