Risk Charts Illustrating the 10-year Risk of Stroke among Residents of Japanese Rural Communities: The JMS Cohort Study

Background

Risk charts are used to estimate the risk of cardiovascular diseases; however, most have been developed in Western countries. In Japan, currently available risk charts are based on mortality data. Using data on cardiovascular disease incidence from the JMS Cohort Study, we developed charts that illustrated the risk of stroke.

Methods and Results

The JMS Cohort Study is a community-based cohort study of cardiovascular disease. Baseline data were obtained between 1992 and 1995. In the present analysis, the participants were 12 276 subjects without a history of stroke; the follow-up period was 10.7 years. Color-coded risk charts were created by using Cox’s proportional hazards models to calculate 10-year absolute risks associated with sex, age, smoking status, diabetes status, and systolic blood pressure. The risks of stroke and cerebral infarction rose as age and systolic blood pressure increased. Although the risk of cerebral hemorrhage were generally lower than that of cerebral infarction, the patterns of association with risk factors were similar.

Conclusion

These risk charts should prove useful for clinicians and other health professionals who are required to estimate an individual’s risk for stroke.Key words: stroke, blood pressure, smoking, diabetes mellitus, cohort study     

Plasma Adiponectin Level and Myocardial Infarction: the JMS Cohort Study

Background

Adiponectin is associated with many cardiovascular risk factors. Thus, a relation between adiponectin and subsequent coronary heart disease has been hypothesized. However, the results of prospective studies have been conflicting.

Methods

In this nested case-control study, blood samples were collected from 5243 of 12 490 community residents enrolled in the Jichi Medical School Cohort Study. The samples were taken between 1992 and 1995 and stored until 2007, at which point the plasma adiponectin level was measured.

Results

During an average of 9.4 years of follow-up, 38 patients with myocardial infarction and 89 controls matched for age, sex, and community were identified. Plasma adiponectin concentration did not significantly differ between cases and controls (geometric mean 7.6 [interquartile range, 5.0–12.2] versus 7.4 [5.4–11.0] mg/L, respectively, P = 0.57). The odds of myocardial infarction in the lowest tertile of adiponectin concentration was not significantly different from that in the highest tertile, after adjustment for age and sex (OR 1.33; 95% CI, 0.50–3.55) or after further adjustment for other cardiovascular risk factors (OR 1.68; 95% CI, 0.45–6.25). Similarly, there was no significant difference in odds of myocardial infarction between the lowest and highest quartiles of adiponectin concentration.

Conclusion

The results do not support an association between hypoadiponectinemia and myocardial infarction.Key words: adiponectin, myocardial infarction, atherosclerosis, prospective studies, Japan     

农村居民与城市居民急性心肌梗死的临床特点及危险因素分析

目的探讨农村和城市居民急性心肌梗死(AMI)危险因素的差异。方法回顾性分析农村、城市AMI患者的临床特点、发病年龄、既往史、吸烟、高血压、糖尿病和高血脂等危险因素,并进行对比研究。结果农村和城市患者年龄无明显差别;城市居民AMI危险因素依次为高血压、低密度脂蛋白升高、高血压加脑梗死、高血脂、糖尿病和高密度脂蛋白降低;农村居民AMI危险因素依次为高血压、高血压加脑梗死、胆固醇升高和高密度脂蛋白降低;城市早期就诊率高于农村。结论农村和城市居民AMI发病平均年龄、临床特点相似,危险因素略有差别。     

Amount and Frequency of Alcohol Consumption and All-Cause Mortality in a Japanese Population: The JMS Cohort Study

Background

Lower mortality has been reported in light-to-moderate alcohol drinkers. We examined the association between the amount and frequency of alcohol consumption and all-cause mortality in a Japanese population.

Methods

We conducted a prospective cohort study among 8934 Japanese people (3444 men and 5490 women) who completed a baseline survey between 1992 and 1995. We confirmed the date and cause of death by referring to death certificates. The Cox proportional hazards model was used to evaluate the effect of alcohol consumption on risk for all-cause mortality, after adjustment for potential confounding factors.

Results

We identified 637 (397 men and 240 women) deaths during the 12.0 years of mean follow-up. Among men, as compared with non-drinkers, the relative risk was higher in ex-drinkers (hazard ratio [HR], 1.18), lower in light drinkers (HR, 0.95) and moderate drinkers (HR, 0.91), and significantly higher in heavy drinkers (HR, 1.67; 95% confidence interval, 1.10–2.55). Among women, light, moderate, and heavy drinkers were grouped into current drinkers. The relative risk was slightly higher in current drinkers (HR, 1.23), and that in ex-drinkers was near 1.0 (HR, 0.97). In stratified analysis, the harmful effects of heavy drinking were more severe among male smokers and younger men. In terms of frequency, men who drank only on special occasions had the highest mortality (HR, 1.28), regardless of alcohol intake per drinking session.

Conclusions

In men, a near J-shaped association was identified between alcohol consumption and all-cause mortality. Both the amount and frequency of alcohol consumption were related to mortality.Key words: cohort studies, alcohol drinking, mortality, Japan     

海宁市农村居民代谢综合征及相关因素的现况研究

目的 探讨海宁市农村居民代谢综合征(MS)患病危险因素,为MS及相关慢性病防控提供依据.方法 通过多阶段分层整群抽样的方法,随机抽取4个镇(街道)18岁及以上居民1475人进行问卷调查、体格检查和实验室检测.结果 海宁市农村居民MS标化患病率为16.21%,男性为10.47%,女性为21.59%,男女患病率差异有统计学意义(P＜0.01);单因素及多因素分析结果显示女性、年龄增大、高血压家族史、超重和肥胖是MS的危险因素,经常吃新鲜蔬菜和水果是保护因素.结论 海宁市农村居民MS患病率较高,特别是40岁以上女性人群,应积极采取针对性措施,预防和控制MS及心脑血管疾病的发生.     

Incidence of total stroke, stroke subtypes, and myocardial infarction in the Japanese population: the JMS Cohort Study

Background

Previous reports indicated that the incidence rate of stroke was higher in Japan than in Western countries, but the converse was true in the case of myocardial infarction (MI). However, few population-based studies on the incidence rates of stroke and MI have been conducted in Japan.

Methods

The Jichi Medical School (JMS) Cohort Study is a multicenter population-based cohort study that was conducted in 12 districts in Japan. Baseline data were collected between April 1992 and July 1995. We examined samples from 4,869 men and 7,519 women, whose mean ages were 55.2 and 55.3 years, respectively. The incidence of stroke, stroke subtypes, and MI were monitored.

Results

The mean follow-up duration was 10.7 years. A total of 229 strokes and 64 MIs occurred in men, and 221 strokes and 28 MIs occurred in women. The age-adjusted incidence rates (per 100,000 person-years) of stroke were 332 and 221 and those of MI were 84 and 31 in men and women, respectively. In the case of both sexes, the incidence rates of stroke and MI were the highest in the group of subjects aged > 70 years.

Conclusion

We reported current data on the incidence rates of stroke and MI in Japan. The incidence rate of stroke remains high, considerably higher than that of MI, in both men and women. The incidence rates of both stroke and MI were higher in men than in women.Key words: Incidence, Stroke, Myocardial Infarction, Cohort Studies, Asian Continental Ancestry Group     

Body mass index and stroke incidence in Japanese community residents: The Jichi Medical School (JMS) Cohort Study

Background

High body mass index (BMI) has been reported as a risk factor for cardiovascular events in Western countries, while low BMI has been reported as a risk factor for cardiovascular death in Asian countries, including Japan. Although stroke is a major cause of death and disability in Japan, few cohort studies have examined the association between BMI and stroke incidence in Japan. This study aimed to examine the association between BMI and stroke incidence using prospective data from Japanese community residents.

Distance, Use of Resources, and Mortality Among Rural Missouri Residents With Acute Myocardial Infarction

Abstract: Prompt access to medical services is considered critical in managing acute myocardial infarction (AMI). Several socioeconomic and geographic factors affect access to such care in rural areas. This study measured the effect of geographic distance from care on utilization of cardiovascular technology and death after AMI. The records of 1,658 rural Missouri residents age 65 or older with a discharge diagnosis of AMI in 1991 were obtained from Medicare data. The rate of use of cardiovascular technology and rate of post-AMI mortality for rural Missouri residents who live far from emergency departments and cardiac referral centers (CRC) were compared with those who live nearest such services. Those living 60 miles or more from a CRC were less likely to have cardiac catheterization (odds ratio [OR]=0.55; 95% confidence interval [CI]=0.40 to 0.75) or angioplasty (OR=0.68; 95% CI=0.47 to 0.98), compared with those living fewer than 30 miles from a CRC. There were no differences in 30-day, 90-day, or one-year mortality rates. After adjusting for distance to a CRC, those living 20 miles or more from emergency services were more likely to have coronary artery bypass grafting (OR=1.92; 95% CI=1.18 to 3.15) than those living fewer than 10 miles from such services, but there was no difference in mortality. Distance from services strongly predicts utilization of cardiovascular resources, but it does not predict mortality among rural Missouri Medicare beneficiaries hospitalized with AMI.     

Association Between Stroke and Metabolic Syndrome in a Japanese Population: Jichi Medical School (JMS) Cohort Study

Background

Metabolic syndrome increases the morbidity and mortality of cardiovascular diseases. However, few studies have examined the association between the incidence of stroke and metabolic syndrome, as defined by Japanese criteria. The aim of this study was to identify the association between stroke and metabolic syndrome, as defined by criteria used in Japan.

Methods

A total of 2205 subjects (920 men and 1285 women) were examined between 1992 and 1995 as part of the Jichi Medical School Cohort Study. Metabolic syndrome was defined using the Japanese criteria. Medical records, computed tomography, and magnetic resonance imaging were used to diagnose stroke. The Cox proportional-hazards model was used to analyze the association between metabolic syndrome and incident stroke.

Results

The prevalence of metabolic syndrome at baseline was 9.0% in men and 1.7% in women. There were 96 incident strokes during an 11.2-year follow-up period, 14 of which occurred in subjects with metabolic syndrome. Among subjects with metabolic syndrome, the age-adjusted hazard ratio (95% confidence interval) for stroke was 1.93 (0.94–3.96) in men and 6.85 (2.68–17.47) in women. After adjusting for age, smoking status, and alcohol drinking status, the hazard ratio was 1.89 (0.88–4.08) in men and 7.24 (2.82–18.58) in women. Age-adjusted hazard ratios associated with having 2 or more components of metabolic syndrome, with and without central obesity, were 2.93 (1.21–7.08) and 3.20 (1.23–8.31) in men and 1.75 (0.69–4.44) and 8.64 (2.82–28.03) in women, respectively.

Conclusions

The presence of metabolic syndrome, as defined by Japanese criteria, increases the risk of stroke; this effect was highly significant among women.Key words: metabolic syndrome X, stroke, cohort studies, incidence, cardiovascular diseases     

Effect of Serum Spermidine on the Prognosis in Patients with Acute Myocardial Infarction: A Cohort Study

Background: Spermidine, a natural polyamine, was found critically involved in cardioprotection and lifespan extension from both animal experiments and human studies. Aims: This study aimed to evaluate the effect of serum spermidine levels on the prognosis in patients with acute myocardial infarction (AMI) and investigate the potential mediation effect of oxidative stress in the above relationship. Methods: We included 377 patients with AMI in a prospective cohort study and measured serum spermidine and oxidative stress indexes (superoxide dismutase enzymes, glutathione peroxidase, and Malondialdehyde) using high-performance liquid chromatography with fluorescence detector and enzyme-linked immunosorbent assay, respectively. The associations of spermidine with AMI outcomes were evaluated using Cox proportional hazards models. Results: 84 (22.3%) major adverse cardiac events (MACE) were documented during a mean follow-up of 12.3 ± 4.2 months. After multivariable adjustment, participants with serum spermidine levels of ≥15.38 ng/mL (T3) and 7.59–5.38 ng/mL (T2) had hazard ratio (HR) for recurrent AMI of 0.450 [95% confidence interval (CI): 0.213–0.984] and 0.441 (95% CI: 0.215–0.907) compared with the ≤7.59 ng/mL (T1), respectively. Participants in T3 and T2 had HR for MACE of 0.566 (95% CI: 0.329–0.947) and 0.516 (95% CI: 0.298–0.893) compared with T1. A faint J-shaped association was observed between serum spermidine levels and the risk of MACE (p-nonlinearity = 0.036). Comparisons of areas under receiver operator characteristics curves confirmed that a model including serum spermidine levels had greater predictive power than the one without it (0.733 versus 0.701, p = 0.041). A marginal statistically significant mediation effect of superoxide dismutase was shown on the association between spermidine and MACE (p = 0.091). Conclusions: Serum spermidine was associated with an improved prognosis in individuals with AMI, whereas the underlying mechanism mediated by oxidative stress was not found.     

The Brazilian Family Health Program and Secondary Stroke and Myocardial Infarction Prevention: A 6-Year Cohort Study

Objectives. We compared the incidence of recurrent or fatal cardiovascular disease in patients using Brazil’s government-run Family Health Program (FHP) with those using non-FHP models of care.Methods. From 2005 to 2010, we followed outpatients discharged from city public hospitals after a first ever stroke for stroke recurrence and myocardial infarction, using data from all city hospitals, death certificates, and outpatient monitoring in state-run and private units.Results. In the follow-up period, 103 patients in the FHP units and 138 in the non-FHP units had exclusively state-run care. Stroke or myocardial infarction occurred in 30.1% of patients in the FHP group and 36.2% of patients in non-FHP care (rate ratio [RR] = 0.85; 95% confidence interval [CI] = 0.61, 1.18; P = .39); 37.9% of patients in FHP care and 54.3% in non-FHP care (RR = 0.68; 95% CI = 0.50, 0.92; P = .01) died. FHP use was associated with lower hazard of death from all causes (hazard ratio [HR] = 0.58; P = .005) after adjusting for age and stroke severity. The absolute risk reduction for death by all causes was 16.4%.Conclusions. FHP care is more effective than is non-FHP care at preventing death from secondary stroke and myocardial infarction.Most strokes occur in low- and middle-income countries, where the disability-adjusted life-years and hospitalization costs are high.1,2 As the young populations of these countries age, stroke incidence and burden will probably rise.3,4 Therefore, it is important to evaluate and implement the best strategy for the primary and secondary prevention of stroke and myocardial infarction in these countries.5In Brazil, the state-run health care system is universal. Three quarters of the population use it exclusively and one quarter uses both public and private health services. In 1994 the Unified National Health System was reorganized to prioritize a new model of care called the Family Health Program (FHP).6 The Brazilian FHP model is centered on a family and community approach in which a multiprofessional team (consisting of a doctor, a nurse, an auxiliary nurse, and 4–6 community health workers) provides comprehensive care.6,7 Family health care teams are assigned to specific geographical areas and populations of 600 to 1000 families and are responsible for permanent and systematic follow-up of a given number of families living in a circumscribed area and for establishing ties of commitment and shared responsibility.6–8 The program was expanded from a minor pilot program covering very few selected areas in 1994 to a nationwide large-scale program in 2006. Today, the FHP covers more than 100 million people in more than 90% of Brazilian municipalities.6–8 From 1996 to 2004, in Brazilian cities where the FHP had intermediate city population coverage (30.0%–69.9% coverage, or > 70.0% coverage and duration of < 4 years), the adjusted infant mortality rate decreased 16%. In cities with complete city coverage (coverage of > 70.0% and duration of > 4 years), it decreased by 22%.9 The remaining population is covered by the traditional model of primary care. In this model, created before the FHP, a multidisciplinary team, composed of general practitioners, gynecologists, pediatricians, dentists, nurses, and auxiliary nurses, works on demand. This is still the most prevalent model in the country and, unlike the FHP model, has no community health workers and no limits to the number of families it can care for.9,10To our knowledge, there is no clear evidence of the effectiveness of Brazil’s FHP model for preventing secondary stroke and myocardial infarction.10 Joinville is an industrial city in southern Brazil, where two thirds of the citizens are covered exclusively by the state-run health care system and the remaining third by both state-run and private care, mostly through employers. We have shown that the incidence, mortality, and 30-day case fatality of first ever stroke decreased in Joinville by one third from 1995 to 2005.11 To determine what happens to those patients when they return to the state-run health units, we compared stroke recurrence, myocardial infarction, and death among patients surviving their first ever stroke who were followed in the FHP units with those followed in non-FHP units.     

浙江省农村居民抗生素滥用原因的定性研究

目的 了解农村居民滥用抗生素的深层原因,为推动农村居民合理使用抗生素提供政策建议.方法 通过立意抽样对36名村民进行深度访谈,鼓励受访者结合患病和治疗经历论述其观点.结果 大多数村民不清楚抗生素的概念,认为抗生素等同于消炎药,常见症状和疾病等同于"炎症",秉持"有炎症吃抗生素"的思维定式.这种思维定式主要来源于医生的诊...     

White Rice Consumption and Risk of Colorectal Cancer Among Japanese Americans: The Multiethnic Cohort Study

BackgroundWhite rice is a staple food for Japanese, a population at high risk for colorectal cancer (CRC). We investigated the association between white rice intake and CRC among Japanese Americans in the Multiethnic Cohort (MEC) study.MethodsThe MEC study is a prospective study established in Hawaii and California in 1993–1996. Usual dietary intake was assessed using a validated quantitative food frequency questionnaire at baseline. Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for quartiles of intake and to perform trend tests across sex-specific quartiles with adjustment for relevant confounders.ResultsWe identified 1,553 invasive CRC cases among 49,136 Japanese Americans (23,595 men and 25,541 women) during a mean follow-up of 19 years. White rice consumption was not associated with overall CRC incidence in men (P_trend = 0.11) or women (P_trend = 0.56). After excluding participants with a history of diabetes, the inverse associations were significant for CRC (P_trend = 0.03, HR for quartile 4 [Q4] vs quartile 1 [Q1], 0.81; 95% CI, 0.64–1.03) and tumors of the distal colon (P_trend = 0.006, HR for Q4 vs Q1, 0.66; 95% CI, 0.44–0.99) among men but not women.ConclusionWhite rice consumption was not associated with an increased risk of overall CRC among Japanese Americans. An inverse association was observed with risk of CRC and distal colon cancer in men without a history of diabetes.Key words: white rice, nutrition, colorectal cancer, Japanese, prospective study     

Risk Factors for Acute Myocardial Infarction in Central India: A Case-Control Study

Background:

Atherosclerosis is a multi-factorial disease involving the interplay of genetic and environmental factors. Studies highlighting the public health importance of risk factors like chronic infections causing acute myocardial infarction (AMI) in the Indian context are scarce. This study was undertaken to study the association of socio-demographic and life-style factors with acute myocardial infarction in central India.

Materials and Methods:

The cases and controls were group-matched for age, gender, and socio-economic status. A blinded research associate administered the study questionnaire. We performed an unconditional multiple logistic regression analysis.

Results:

The case-control study included 265 cases of AMI and 265 controls. The results of final model of logistic regression analysis for risk factors of AMI included 11 risk factors at α = 0.05. They were waist hip ratio, body mass index, stress at home in last 1 year, hypertension, family history of CHD, past history of gingival sepsis, tobacco smoking, raised total serum cholesterol, Chlamydia pneumoniae, Helicobacter pylori and raised C-reactive protein.

Conclusion:

The findings confirm the role of conventional risk factors for cardiac disease and highlight need for research into the association between chronic infections with AMI.     

延边农村社区朝鲜族居民高血压知识的现况调查

目的 了解延边农村社区朝鲜族居民的高血压知识水平的现状。方法 采用随机整群抽样法，对图们市月晴镇的朝鲜族农民进行了问卷调查。结果 在满分为２３分的题目测试中，平均得分为１０．２２±３．６６分，未达到及格水平。社区人群自己血压水平的知晓率为３７．３％，每日钠盐摄入的标准知晓率仅为２．１％。有５１．３％的农民喜吃高盐饮食，其中，愿意减盐饮食占５１．２％；准备合理饮食愿望的占１５．３％；大量饮酒率为１     

农村居民重大疾病保障水平适宜度研究

目的:构建农村居民重大疾病保障适宜度模型,为提高农村居民重大疾病保障水平提出政策建议。方法:在文献分析的基础上,依据社会保障适宜度理论,构建农村居民重大疾病保障适宜度模型,并测算保障水平适宜度范围,对四个样本地区农村居民重大疾病保障水平适宜度进行判别。结果:溧阳和高邮两个样本地区的重大疾病保障水平已达到适度保障的目标,丹徒和大丰两个地区的重大疾病保障水平较低、低于适度水平的下限值。结论:要适度提高农村居民重大疾病保障水平,当达到适度保障目标后,需要控制重大疾病保障水平的增长速度。     

Dairy Consumption and 3-Year Risk of Type 2 Diabetes after Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort

Population-based studies suggest a role for dairy, especially yogurt, in the prevention of type 2 diabetes (T2D). Whether dairy affects T2D risk after myocardial infarction (MI) is unknown. We examined associations of (types of) dairy with T2D incidence in drug-treated, post-MI patients from the Alpha Omega Cohort. The analysis included 3401 patients (80% men) aged 60–80 y who were free of T2D at baseline (2002–2006). Dairy intakes were assessed using a validated food-frequency questionnaire. Incident T2D was ascertained through self-reported physician diagnosis and/or medication use. Multivariable Cox models were used to calculate Hazard ratios (HRs) and 95% confidence intervals (CI) for T2D with dairy intake in categories and per 1-standard deviation (SD) increment. Most patients consumed dairy, and median intakes were 264 g/d for total dairy, 82 g/d for milk and 41 g/d for yogurt. During 40 months of follow-up (10,714 person-years), 186 patients developed T2D. After adjustment for confounders, including diet, HRs per 1-SD were 1.06 (95% CI 0.91–1.22) for total dairy, 1.02 (0.88–1.18) for milk and 1.04 (0.90–1.20) for yogurt. Associations were also absent for other dairy types and in dairy categories (all p-trend > 0.05). Our findings suggest no major role for dairy consumption in T2D prevention after MI.     

Marital status and mortality among Japanese men and women: the Japan Collaborative Cohort Study

Background  

Several studies have indicated a significant association between marital status and mortality risks. However, most of these studies have compared married and unmarried people without differentiating among single, divorced and widowed status. Moreover, gender differences in mortality rates associated with marital status have not been sufficiently clarified. With significant increases in the percentages of divorced and widowed people and a corresponding drop in the marriage rate in Japan during the past two or three decades, it can be expected that these changes will have a significant impact on mortality rates.