Role of Hypertension, Dyslipidemia and Diabetes Mellitus in the Development of Coronary Atherosclerosis in Japan

Washio, Masakazu; Sasazuki, Shizuka; Kodama, Hiroko; Yoshimasu, Kouichi; Liu, Ying; Tanaka, Keitaro; Shoji, Tetsuo; Kono, Suminori; Arai, Hidekazu; Koyanagi, Samon; Hiyamuta, Kohji; Doi, Yoshiko; Kawano, Teruaki; Nakagaki, Osamu; Takada, Kazuyuki; Nii, Takenobu; Shirai, Kohji; Ideishi, Munehito; Arakawa, Kikuo; Mohri, Masahiro; Takeshita, Akira

doi:10.1253/jcj.65.731

Cited by 29 publications

(16 citation statements)

References 61 publications

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“…Because TG values fluctuate markedly after meals and [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] the assay procedure for HDL-C was standardized more easily than that for TG, HDL-C has long been used as a parameter, taking the place of TG in practice in the clinic and the use of TG in judging the appropriateness of the treatment of hyperlipidemia has long been ignored in epidemiological studies (25). However, meta-analysis of epidemiological data (26,27) has shown that TG is an independent cardiovascular risk factor and evidence has accumulated over the past ten years showing the importance of TG as an independent risk factor in CAD (28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

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Life Style and Cardiovascular Risk Factors in the Japanese Population-From an Epidemiological Survey on Serum Lipid Levels in Japan 1990. Part 2: Association of Lipid Parameters with Hypertension

Yamamoto¹,

Temba²,

Horibe

et al. 2003

JAT

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The importance of metabolic syndrome as a risk factor of coronary artery disease (CAD) has recently become more and more recognized. In view of such a background, changes in cholesterol and other lipid parameters in the Japanese population associated with excess body weight and hypertension were analyzed in this study based on data obtained in an epidemiological survey carried out in 1990. Hypertension was closely associated with a higher body mass index (BMI). Among the lipid parameters, triglyceride (TG) and non-HDL-C (total cholesterol minus HDL-cholesterol) levels showed remarkable differences between hypertensive and normotensive subjects, with a greater statistical significance than LDL-cholesterol (LDL-C) levels. Changes in lipid parameters in the presence of hypertension were mostly associated with an increase in BMI in younger men aged 20-39, while increases in TG levels took place independently of excess body weight in middle-aged (40-59-year old) men. Considering that hypertension is a common and the greatest risk factor in the Japanese population, TG and non-HDL-C appear to be more important than LDL-C as major lipid parameters related to atherogenesis. J Atheroscler Thromb, 2003; 10: 176-185.

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Section: Discussionmentioning

confidence: 99%

“…In view of the recent recognition of the importance of metabolic risk factor syndrome (17,18,36), the significance of TG and non-HDL-C as a predictor of CAD should be re-examined more carefully in future epidemiological studies.…”

Section: Discussionmentioning

confidence: 99%

Life Style and Cardiovascular Risk Factors in the Japanese Population-From an Epidemiological Survey on Serum Lipid Levels in Japan 1990. Part 2: Association of Lipid Parameters with Hypertension

Yamamoto¹,

Temba²,

Horibe

et al. 2003

JAT

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“…Inadequate treatment for hypercholesterolemia is a matter of concern because hypercholesterolemia has become an important cause of CHD events in Japan. 18,28,29 A randomized controlled trial is a desirable design for investigating the efficacy of medical treatment for hypercholesterolemia in the prevention of CHD events, but is not feasible in populations with a low risk of CHD, and randomization may be affected by reluctance among medical professionals as well as patients in populations with different cultures, as was illustrated in a large-scale clinical trial of statin in Japan. 17,30 Under those circumstances, observational evidence would be of value when evidence from randomized trials is applied to a population with different characteristics.…”

Section: Discussionmentioning

confidence: 99%

Medication for Hypercholesterolemia and the Risk of Nonfatal Acute Myocardial Infarction. A Case-Control Study in Japan.

Kodama

Kono

Liu

et al. 2002

Circ J

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levated levels of serum total or low-density lipoprotein cholesterol have been related to increased risk of coronary heart disease (CHD) in many prospective studies in Western countries, [1][2][3][4] and it has been consistently shown in randomized controlled trials that lowering blood cholesterol reduces both the incidence and recurrence of CHD events. [5][6][7][8][9][10][11][12][13] A positive association between serum total cholesterol and CHD has been observed in Asian populations with relatively low levels of serum total cholesterol and at low risk of CHD, 14,15 but it is unclear whether the beneficial effect of lowering blood cholesterol observed in Western populations is directly applicable to Japanese subjects with hypercholesterolemia. A small clinical trial in Japan showed that the use of pravastatin resulted in regression of coronary atherosclerosis, 16 but a randomized controlled trial regarding the prevention of CHD events by medication for hypercholesterolemia has never been successfully completed. 17 We designed a case -control study, the Fukuoka Heart Study, 18,19 to investigate the relationship between medication for hypercholesterolemia and the risk of nonfatal acute myocardial infarction (AMI) in Japanese men and women. MethodsThe study was designed and implemented in accordance with the Declaration of Helsinki adopted by the 18th World Circulation Journal Vol.66, May 2002Medical Assembly; observational studies were not the subject of review by the institutional ethical committee at the time of the survey. Study subjects were patients with a first episode of AMI and matched community controls. Written informed consent was given by all participating individuals. Cases and ControlsEligible cases were patients aged 40-79 years who were admitted to hospital for a first AMI during September 1996 to September 1998 and who recovered well enough to be interviewed within 1 month after the onset of AMI. The eligible cases were originally restricted to residents of Fukuoka City, but were extended to those of 21 adjacent municipalities in June 1997. Thirteen hospitals were selected to cover the patients in Fukuoka City when the study began, and 9 other hospitals outside Fukuoka City were subsequently included. These collaborating hospitals were staffed with one or more expert cardiologists and were equipped with facilities for treating AMI.Research nurses visited each hospital weekly, checked all admissions with a diagnosis of AMI or suspected AMI, and asked eligible patients to participate in the study. Collaborator cardiologists were in charge of the diagnosis of AMI, which was made on the basis of electrocardiographic findings, ischemic cardiac pain lasting at least 30 min, and enzyme changes in accordance with the criteria used in the Lipid Research Clinics Coronary Primary Prevention Trial. 20 Of 756 eligible patients, a total of 660 (87%) participated in the study. Reasons for non-participation were impaired ability to communicate (n=9), discharge before interview (n=65), and refusal (n=22). Two cas...

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“…Hypertriglyceridemia is often associated with low-HDL-C, both of which are integral components of metabolic syndrome 36,37) . Several case-control studies including ours [38][39][40][41] and a prospective observational study 42) have shown that low-HDL-C and high triglyceride are important risk factors for CHD as well as hypercholesterolemia. Recent studies suggest that high triglyceride and/or low HDL-C are strongly associated with the predominance of highly atherogenic small dense LDL 41,[43][44][45] .…”

Section: Hypertriglyceridemia Low Hdl-c and Chdmentioning

confidence: 99%

Treatment of Hyperlipidemia from Japanese Evidence

Koba

Sasaki

2006

JAT

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The treatment of hyperlipidemia is aimed at preventing cardiovascular disease (CVD) and coronary heart disease (CHD). As the incidence of CHD in Japan is about one-third lower and that of stroke is two-fold higher compared to Western countries, and the doses of lipid-lowering drugs used in foreign randomized controlled clinical trials (RCTs) are much higher than in general use in Japan, it remains unclear whether the results of RCTs conducted in Western countries could be extrapolated to Japanese patients. Recently, two major large-scale, prospective, RCTs in Japanese hypercholesterolmic patients, the Management of Elevated Cholesterol in the Primary Prevention of Adult Japanese (MEGA) study and the Japan EPA Lipid Intervention Study (JELIS), have been reported. Japanese epidemiological studies and Japanese clinical studies are reviewed. The evidence suggests that hypercholesterolemia, hypertriglyceridemia, and low HDL-cholesterol are strongly associated with increased CHD risk. Lipid-lowering medication shows beneficial effects even in low-risk populations; however, the data did not support that lower cholesterol is better. The safety and efficacy of hyperlipidemia treatment in Japanese patients are discussed.

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Role of Hypertension, Dyslipidemia and Diabetes Mellitus in the Development of Coronary Atherosclerosis in Japan

Cited by 29 publications

References 61 publications

Life Style and Cardiovascular Risk Factors in the Japanese Population-From an Epidemiological Survey on Serum Lipid Levels in Japan 1990. Part 2: Association of Lipid Parameters with Hypertension

Life Style and Cardiovascular Risk Factors in the Japanese Population-From an Epidemiological Survey on Serum Lipid Levels in Japan 1990. Part 2: Association of Lipid Parameters with Hypertension

Medication for Hypercholesterolemia and the Risk of Nonfatal Acute Myocardial Infarction. A Case-Control Study in Japan.

Treatment of Hyperlipidemia from Japanese Evidence

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