Kazumasa Yamagishi

Fermented Soy Product Intake Is Inversely Associated with the Development of High Blood Pressure: The Japan Public Health Center–Based Prospective Study

Background: Randomized controlled studies have investigated the short-term effect of soy product intake on blood pressure (BP) in normotensive people. To our knowledge, no prospective studies exist on the effect of habitual intake of fermented soy products, separate from total soy products, on BP in the general population.Objective: We examined the association between the habitual intake of soy products, including fermented soy products, and the development of high BP during a 5-y period among participants in a population-based prospective cohort study in Japan.Methods: The study included normotensive participants aged 40-69 y at baseline (926 men and 3239 women) who completed 2 questionnaires and whose BP was measured at the baseline survey between 1993 and 1994 and the 5-y follow-up in the Japan Public Health Center-Based Prospective Study Cohort II. The intake of soy products was assessed with a food-frequency questionnaire. High BP was defined as systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥85 mm Hg, or antihypertensive medication use. ORs and 95% CIs of high BP by frequency of soy products (miso, natto, and tofu) consumption, intake of total and fermented soy products, and intake of isoflavones from total and fermented soy products were estimated with the use of multiple logistic regression analysis.Results: Multivariable-adjusted ORs of high BP for the highest compared with the lowest tertile of total and fermented soy product intake were 1.03 (95% CI: 0.84, 1.25; P-trend = 0.786) and 0.72 (95% CI: 0.56, 0.92; P-trend = 0.009), respectively. The frequency of nonfermented soy product (tofu) intake was not associated with the development of high BP (P-trend = 0.597).Conclusions: The intake of fermented soy products, but not total or nonfermented soy products, was inversely associated with developing high BP in men and women with normal BP.

Association of high-density lipoprotein cholesterol concentration with different types of stroke and coronary heart disease: The Japan Public Health Center-based prospective (JPHC) study

BACKGROUND AND AIMSnAlthough low high-density lipoprotein (HDL) cholesterol concentration is an established risk factor for coronary heart disease (CHD), information regarding subtypes of stroke is very limited, especially in Asian populations.nnnMETHODSnA prospective study was conducted among 30,736 individuals aged 40-69xa0years, who lived in nine communities in Japan and did not have a history of cardiovascular disease (CVD). CHD and stroke, including its subtypes, were assessed, and sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes were estimated according to quintiles of HDL cholesterol using Cox proportional models adjusted for other CVD risk factors.nnnRESULTSnWe identified 296 CHD and 1712 stroke events over a median 15xa0yr of follow-up. HDL cholesterol concentration showed an inverse association with CHD in men and women. A low HDL cholesterol concentration slightly raised the risk for total strokes in men, but not in women. When analyzed by subtypes, we observed an inverse relationship between HDL cholesterol concentration and the incidence of lacunar infarction, with an adjusted HR for the lowest quintile of HDL cholesterol concentration compared with the highest quintile of 1.63 (95% CI, 1.00-2.66) in men and 1.97 (95% CI, 1.19-3.26) in women. HDL cholesterol concentration was positively associated with the risk of intracerebral hemorrhage (ICH) in a linear manner in women (p for trendxa0=xa00.028), but not in men.nnnCONCLUSIONSnThe associations of HDL cholesterol concentration with lacunar infarction and ICH may be related to different functional properties of HDL rather than to its protective function against lipid-rich atherosclerosis.

Passive smoking and mortality from aortic dissection or aneurysm

BACKGROUND AND AIMSnEvidence on the association between passive smoking and risk of aortic dissection or aneurysm is limited. This study aimed to investigate whether passive smoking increases risk of mortality from aortic dissection or aneurysm.nnnMETHODSnThe Japan Collaborative Cohort (JACC) Study is a prospective community-based cohort study begun in 1988-90 and followed up to the end of 2009. We examined 48,677 individuals (mean age, 56 years; women, 46%) without history of stroke, coronary heart disease, or cancer, who provided valid responses to a lifestyle questionnaire including questions on active and passive smoking. We used 3 categories (passive smoking out of home, passive smoking at home, and passive smoking out of or at home combined) to divide never-smokers into 3 exposure groups: low, intermediate, and high exposures, respectively. The endpoint was underlying cause of death from aortic dissection or aneurysm.nnnRESULTSnDuring the median 19-year follow-up of 48,677 study participants, 66 died of aortic dissection, and 75 of aortic aneurysm. Multivariable hazard ratios (95% confidence intervals) for the high passive-smoking group as compared with the low passive-smoking group were 2.45 (1.02-5.88) out of home, 1.82 (0.84-3.96) at home, and 2.35 (1.09-5.09) out of or at home combined. The corresponding hazard ratios for current smokers as compared with the low passive-smoking group were 3.97 (2.14-7.39), 3.41 (1.84-6.32) and 4.09 (1.99-8.39), respectively.nnnCONCLUSIONSnOut-of-home passive smoking and out-of- or at-home combined passive smoking were associated with increased mortality from aortic dissection or aneurysm.

Soluble Vascular Cell Adhesion Molecule and Cardiovascular Disease: An Epidemiological View

Novel biomarkers for primary prevention of cardiovascular disease have been evaluated worldwide, but few appeared to improve risk prediction beyond classical risk factors, such as high blood pressures, dyslipidemias, and hyperglycemias. Soluble cell adhesion molecules have been considered early systemic inflammation and endothelial cell activation markers and risk marker for consequent development of cardiovascular disease. Thus, high levels of these circulating molecules have been hypothesized to be associated with higher risk of cardiovascular disease. Of these molecules, the evidence on the predictive role of soluble vascular cell adhesion molecule-I (VCAM-I) has been relatively limited, and most previous studies have shown no association. In this issue of the Journal of Atherosclerosis and Thrombosis, Kunutsor et al. examined the association between soluble VCAM-I plasma levels and incident cardiovascular disease (coronary heart disease and stroke) in the Prevention of Renal and Vascular Endstage Disease (PREVEND) Study, a prospective cohort study of a general population living in the city of Groningen, the Netherlands. They found a weak correlation between VCAM-I and classical risk factors, and unexpectedly, an inverse association between VCAM-1 and risk of cardiovascular disease (primarily coronary heart disease) after adjustment for, or stratification by, classical risk factors. VCAM-I did not improve cardiovascular disease risk assessment beyond classical risk factors. The PREVEND Study is a well-designed national representative prospective cohort study. However, the result from a single study, when the results were not consistent with those of prior hypotheses, should be interpreted with caution. Generally, high levels of VCAM-I are considered to be linked with high risk of cardiovascular disease. The authors carefully tested the possibility of bias, such as reverse causation, confounders, and interaction with other classical factors, and noted several limitations: residual confounding, absence of repeat measurements, generalizability to other ethnicities, and plasma storage. In addition, they did not evaluate the amount of alcohol intake, and the high amount may damage endothelial function. Further studies are needed to confirm the results, and using VCAM-1 for the prediction of future cardiovascular disease may not be practical in clinical/public health settings at this moment. Nonetheless, this study turned the spotlight on the role of VCAM-1 on the development of cardiovascular disease. Taken together with previous studies with the null association in the general population, VCAM-1 may play a different role in the pathogenesis of atherosclerosis with other adhesion molecules. The authors speculated several mechanisms that may explain the difference. Biological mechanisms underlying the inverse association should be revealed to determine whether VCAM-1 could be a protective marker.

Usefulness of Skinfold Thickness Measurements for Determining Body Fat Distribution and Disease Risk for Japanese Men and Women

Subscapular and triceps skinfold thickness (SSF and TSF) as well as body mass index (BMI) were investigated as indices for body fat distribution between 1976 and 2007 in rural and urban communities in conjunction with the Circulatory Risk in Communities Study (CIRCS). Mean BMI did not change between 1976 and 1987 and increased thereafter for men of every age group in both rural and urban communities. There were no remarkable changes in BMI levels for women of any age groups, except for rural women aged 40–49 and urban women aged 40–59 whose mean BMI declined over time. Mean SSF and TSF did not change from between 1976 and 1987 and increased thereafter for men and women of every age group in both rural and urban communities, except for urban women aged 40–59 whose mean SSF declined over time. BMI, SSF and TSF correlated positively with systolic and diastolic blood pressures and total cholesterol in each survey period for both men and women of rural and urban communities. BMI and SSF correlated positively with serum glucose for rural women and for urban men and women in every survey period, but not for rural men, for whom correlations were weak between 1976 and 1991 and became stronger thereafter. The skinfold thickness measurement is useful to obtain a clearer picture of long-term trends for body fat distribution as well as for its influence on cardiovascular risk factors, which would be difficult to obtained with BMI measurement only.

Cardiovascular disease mortality in relation to physical activity during adolescence and adulthood in Japan: Does school-based sport club participation matter?

We examined potential associations of sport club participation during adolescence and sports-related physical activity during adulthood with mortality from cardiovascular diseases (CVD) in a Japanese population. Between 1988 and 1990, 29,526 men and 41,043 women aged 40-79u202fyears responded to a questionnaire including questions about the frequency of sports participation at baseline and sport club participation during junior/senior high school. Subjects were followed-up until the end of 2009, and 4230 cardiovascular deaths (870 CHD, 1859 stroke) were identified. Cox proportional-hazard regression models were used to estimate hazard ratios (HR). During the first-two thirds of the follow-up - where the proportional hazards assumption was met - the multivariate-adjusted HR (95% confidence interval) for total CVD mortality was 0.77 (0.61-0.98) among men and 0.82 (0.61-1.10) among women who were physically active at baseline (≥5u202fh/week versus 1-2u202fh/week). The corresponding HRs for coronary heart disease (CHD) mortality were 0.65 (0.39-1.07) and 0.40 (0.17-0.91), respectively. The combined associations of sports participation during adulthood and adolescence were also examined. Among men who participated in sports for ≥5u202fh/week at baseline, the multivariate-adjusted HR for those who also engaged in sport club activities during adolescence was 0.89 (0.61-1.30) for total CVD mortality and 0.24 (0.08-0.71) for CHD mortality when compared to non-participants. Among women, no statistically significant differences were found between sport club participants and non-participants. In conclusion, participating in sport clubs during adolescence might lead to a more pronounced risk-reduction for CHD mortality among men who also participate in sport activities during adulthood.

Dietary intakes of fat soluble vitamins as predictors of mortality from heart failure in a large prospective cohort study

OBJECTIVESnA few reports have investigated the association of dietary vitamin intakes with risk of heart failure in Asia. Therefore, we examined the relation between dietary intakes of fat-soluble vitamins A, K, E, and D and mortality from heart failure in the Japanese population.nnnMETHODSnA total of 23 099 men and 35 597 women ages 40 to 79xa0y participated in the Japan Collaborative Cohort Study and completed a food frequency questionnaire from which dietary intakes of vitamins A, K, E, and D were calculated. The Cox proportional hazard model was used to estimate the sex-specific risks of heart failure mortality according to increasing quintiles of fat-soluble vitamin intakes.nnnRESULTSnDuring the median 19.3xa0y follow-up period, there were 567 deaths from heart failure (240 men, 327 women). Dietary vitamin A intake showed no association with heart failure mortality in both sexes; however, the reduced risk was observed in women but not in men with dietary intakes of vitamins K, E, and D. The multivariable hazard ratios (95% confidence interval) in the highest versus the lowest intake quintiles among women were 0.63 (0.45-0.87; P for trendxa0=xa00.006) for vitamin K, 0.55 (0.36-0.78; P for trendxa0=xa00.006) for vitamin E, and 0.66 (0.48-0.93; P for trendxa0=xa00.01) for vitamin D. The association for each vitamin was slightly attenuated but remained statistically significant after mutual adjustment for intakes of the other vitamins.nnnCONCLUSIONSnHigh dietary intakes of fat-soluble vitamins K, E, and D were associated with a reduced risk of heart failure mortality in Japanese women but not men.

Associations between copper and zinc intakes from diet and mortality from cardiovascular disease in a large population-based prospective cohort study

Several studies have related cardiovascular disease (CVD) to serum concentrations of copper and zinc but not to their dietary intakes. We thought to examine the association between dietary intakes of copper and zinc with risk of mortality from CVD in a prospective study encompassing 58,646 healthy Japanese men and women aged 40-79 years. The intakes of copper and zinc were determined by a validated self-administered food frequency questionnaire, and their associations with risk of mortality from CVD were evaluated by Cox proportional hazard modelling. During 965, 970 person-years of follow-up between 1989-2009, we documented 3,388 CVD deaths [1,514 from stroke, 702 from coronary heart disease (CHD) and 1,172 from other CVD]. Copper intake was not associated with CHD mortality; however, the multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality from stroke, other CVD and total CVD in the highest versus the lowest quintiles of copper intake among men were 1.78 (1.16-2.77; P-trend=0.007), 1.61 (1.01-2.81; P-trend =0.03) and 1.63 (1.21-2.33; P-trend=0.001), respectively, and those among women were 1.49 (1.00-2.19; P-trend=0.04), 1.59 (1.09-2.55; P-trend =0.02) and 1.36 (1.06-1.69; P-trend=0.01), respectively. Higher intakes of zinc was inversely associated with mortality from CHD in men; 0.68 (0.58-1.03; P-trend=0.05) but not women; 1.13 (0.71- 1.49; P-trend=0.61). No associations were observed with other mortality endpoints. In conclusion, dietary copper intake was positively associated with mortality from CVD in both genders; whereas, higher dietary zinc intake was inversely associated with mortality from CHD in men but not women.

Dietary Antioxidant Micronutrients and All-Cause Mortality: The Japan Collaborative Cohort Study for Evaluation of Cancer Risk

Background Oxidative stress, the imbalance between pro- and antioxidants, has been implicated in the etiology and pathophysiology of the incidence and mortality of many diseases. We aim to investigate the relations of dietary intakes of vitamin C and E and main carotenoids with all-cause mortality in Japanese men and women. Methods The Japan Collaborative Cohort Study for Evaluation of Cancer Risk had 22,795 men and 35,539 women, aged 40–79 years at baseline (1988–1990), who completed a valid food frequency questionnaire and were followed up to the end of 2009. Results There were 6,179 deaths in men and 5,355 deaths in women during the median follow-up of 18.9 years for men and 19.4 years for women. Multivariate hazard ratios for the highest versus lowest quintile intakes in women were 0.83 (95% confidence interval [CI], 0.76–0.90; P for trend < 0.0001) for vitamin C, 0.85 (95% CI, 0.78–0.93; P for trend < 0.0001) for vitamin E, 0.88 (95% CI, 0.81–0.96; P for trend = 0.0006) for β-carotene, and 0.90 (95% CI, 0.82–0.98; P for trend = 0.0002) for β-cryptoxanthin. The joint effect of any two of these highly correlated micronutrients showed significant 12–17% reductions in risk in the high-intake group compared with the low-intake group in women. These significant associations were also observed in the highest quintile intakes of vitamin C, vitamin E, and β-carotene in female non-smokers but were not observed in female smokers, male smokers, and non-smokers. Conclusions Higher dietary intakes of antioxidant vitamins may reduce the risk of all-cause mortality in middle-aged Japanese women, especially female non-smokers.

Dietary Intake of Energy and Nutrients from Breakfast and Risk of Stroke in The Japanese Population: The Circulatory Risk in Communities Study (CIRCS)

Aims: The frequency of breakfast intake has been reported to be inversely associated with the risk of cardiovascular events; however, it is uncertain what the impact of the energy and nutrient intakes from breakfast are. We assessed the association between these intakes from breakfast and the risk of stroke prospectively. Methods: In a baseline survey of four Japanese communities between 1981 and 1990, we enrolled 3 248 residents (1 662 men and 1 586 women) aged 40–59 years who were free from stroke and heart disease and who responded to the 24-hour dietary recall survey. We assessed the dietary intake at breakfast, lunch, dinner, and other times separately. Results: During the median 25-year follow-up, 230 individuals (147 men and 83 women) developed stroke. After adjustment for age, community, other dietary intakes, and lifestyle and physiological factors, the multivariable-adjusted hazard ratios (95% confidence intervals) of intracerebral hemorrhage for the highest versus lowest quartiles of energy intake from breakfast were 0.38 (0.15–0.99) in men and 1.36 (0.36–5.10) in women. For the major nutrients, a higher saturated or monounsaturated fat intake at breakfast was associated with a reduced risk of intracerebral hemorrhage in men, and remained statistically significant after further adjustment for intake of other major nutrients from breakfast. Conclusions: A higher intake of energy from breakfast, primarily saturated or monounsaturated fat, was associated with a reduced risk of intracerebral hemorrhage in Japanese men.