Mami Iida

Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017

Toray Industries, Inc., Tokyo, Japan Department of Diabetes, Metabolism and Endocrinology, Chiba University Graduate School of Medicine, Chiba, Japan National Center for Geriatrics and Gerontology, Aichi, Japan Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Iwate, Japan Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University, Tochigi, Japan Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan Egusa Genshi Clinic, Hiroshima, Japan Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan Biomedical Informatics, Osaka University, Osaka, Japan Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine, Ehime, Japan Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan Department of Vascular Surgery, Saitama Medical Center, Saitama, Japan Chief Health Management Department, Mitsui Chemicals Inc., Tokyo, Japan Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan Department of Neurology, Kita-Harima Medical Center, Hyogo, Japan Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine, Kanagawa, Japan Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan Tsukasa Health Care Hospital, Kagoshima, Japan Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University, Hyogo, Japan Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women’s University, Tokyo, Japan 25 Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan Department of Medical Statistics, Toho University, Tokyo, Japan Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan Department of Laboratory Medicine, Jikei University Kashiwa Hospital, Chiba, Japan Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan 31 Department of Community Medicine, Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan Rinku General Medical Center, Osaka, Japan

How Should We Effectively Support Smoking Cessation at Health Checkup Opportunity and Induce More Quitters

Smoking causes many diseases such as coronary artery disease, stroke, cancer, diabetes, COPD, and periodontal disease, and it is estimated that more than 130,000 people die from smoking annually in Japan. In comparison of the risk for developing cardiovascular disease, the risk of smoking is almost equal to that of metabolic syndrome, and smoking cessation in cardiovascular disease prevention is highly important even if weight gain was observed after smoking cessation. In the Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 edition, smoking is a risk factor for coronary artery disease, stroke, abdominal aortic aneurysm, and peripheral artery disease, and passive smoking is also a risk factor for coronary artery disease and stroke. For primary and secondary prevention of atherosclerotic cardiovascular diseases, it is strongly recommended to stop smoking and to avoid passive smoking. Metabolic syndrome is recognized as a condition prone to atherosclerotic cardiovascular diseases based on accumulation of visceral fat and increased insulin resistance. Focusing on the condition of accumulation of risk factors to prevent cardiovascular diseases, the Specific Health Checkups and Specific Health Guidance, the Japanese nationwide cardiovascular prevention system, started as metabolic health checkup in Japan . Although smoking was initially only added as an additional risk of stratification, it was obliged to make health guidance for smoking including the day of health checkup due to the revision of the 2013 version. However, health guidance for smoking cannot be done enough now. Health checkup is an opportunity for health consciousness to be raised for examinees, which is a great opportunity to provide individual health promoting information to many examinees. In the guidelines of WHO’s Tobacco Control Framework Convention Article 14 (Demand reduction measures concerning tobacco dependence and cessation) adopted in Uruguay in November 2010, smoking cessation advice is required to be offered at health care sites as a measure to promote smoking cessation in the healthcare system internationally. In this issue, Nakamura and colleagues examined whether specific health guidance promotes smoking cessation among targeted smokers using propensity score matching analysis. They found that in the Japanese cardiovascular prevention system, repeated counseling may promote smoking cessation for obese male smokers classified as active support. This manuscript contains important information on how to effectively use limited time and cost for smoking cessation guidance of many smokers in a routine program. It is important to select candidates who are more effective and to continuously support smoking cessation on an ongoing basis. However, it is reported that short time intervention for smoking cessation at medical examination will raise smoking cessation rate. Therefore, implementing short-term smoking cessation support (ABR: Ask, Brief advice, Refer) including information of smoking cessation treatment such as the effectiveness of smoking cessation aid for about 1 minute for all smokers will give rise to many quitters. Furthermore, it is also important to provide the information on the hazards of secondhand smoke to all examinees including non-smokers .

Comprehensive risk management for the prevention of cerebro- cardiovascular diseases in Japan

Comprehensive risk management for the prevention of cerebro- cardiovascular diseases in Japan

Weight Gain After Smoking Cessation and Atherosclerotic Low-Density Lipoprotein Marker

Smoking is one of the major risk factors for atherosclerosis and develops coronary artery disease, cerebrovascular disease, and peripheral artery disease. It adversely affects the platelet and vascular endothelial function, inflammation, and oxidative stress. Moreover, it increases the incidence of atherogenic lipid profile (higher levels of triglycerides and low-density lipoprotein cholesterol (LDL-C); and lowers the levels of high-density lipoprotein cholesterol (HDL-C)); insulin resistance, including type 2 diabetes; and metabolic syndrome. Therefore, smoking cessation (SC) is the most important matter for the prevention and treatment of atherosclerotic cardiovascular diseases (CVD). On the other hand, SC is often accompanied by weight gain. Recent meta-analysis reported that SC is associated with a mean increase of 4 –5 kg in body weight after 12 months of abstinence, and most weight gain occurs within 3 months of quitting. Weight gain itself is also a risk factor for CVD. SC causes an improvement in insulin sensitivity and an increase in HDL-C, whereas obesity after SC might paradoxically contribute to insulin resistance and atherogenic lipid profile . Therefore, the relationship between SC and weight gain could remain to be a highly relevant subject for further research for preventing and treating CVD. The α1-antitrypsin – low-density lipoprotein complex (AT-LDL) and serum amyloid A-LDL complex (SAA-LDL) are oxidatively modified LDL complexes and are closely associated with both smoking and obesity, which induce oxidative stress and inflammation . One-year time course changes of these two markers and other serum metabolic and inflammatory parameters, as well as body mass index (BMI) and waist circumference, after SC are evaluated in the present study. The authors show that the serum levels of AT-LDL and SAA-LDL were unchanged from baseline to 3 months after SC but these levels significantly decreased from 3 months to 1 year after SC. Although abdominal obesity progressively worsened after SC, the beneficial effect of non-smoking clearly overcomes potential vascular risks by cessation-associated obesity at 1 year after SC. The authors previously reported a significant decrease in serum AT-LDL values among patients with a BMI increase smaller than the median at 3 months after SC. However, large weight gain after SC perturbs the decrease in AT-LDL at 3 months after SC. We consider that the reduced post-cessation weight gain can bring in earlier beneficial effects of SC for oxidatively modified LDL complexes. Furthermore, post-cessation weight gain is indicated to be an essential reason why smokers, especially women, fail to initiate SC or relapse after initiating SC. It is hereafter worth considering for SC programs and therapies, including pharmacological treatment, designed for reducing post-cessation weight gain.