担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

© 2015 The Japanese Society of Hypertension All rights reserved. The aim of this study was to develop a risk prediction model for incident hypertension in a Japanese male population. Study participants included 15 025 nonhypertensive Japanese male workers (mean age, 38.8±8.9 years) who underwent an annual medical checkup at a company. The participants were followed-up for a median of 4.0 years to determine new-onset hypertension, defined as a systolic blood pressure (BP) ≥140 mm Hg, a diastolic BP ≥90 mm Hg, or the initiation of antihypertensive medication. Participants were divided into the following two cohorts for subsequent analyses: the derivation cohort (n=12 020, 80% of the study population) and the validation cohort (n=3005, the remaining 20% of the study population). In the derivation cohort, a multivariate Cox proportional hazards model demonstrated that age, body mass index, systolic and diastolic BP, current smoking status, excessive alcohol intake and parental history of hypertension were independent predictors of incident hypertension. Using these variables, a risk prediction model was constructed to estimate the 4-year risk of incident hypertension. In the validation cohort, the risk prediction model demonstrated high discrimination ability and acceptable calibration, with a C-statistic of 0.861 (95% confidence interval 0.844, 0.877) and a modified Hosmer-Lemeshow χ 2 statistic of 15.2 (P=0.085). A risk score sheet was constructed to enable the simple calculation of the approximate 4-year probability of incident hypertension. In conclusion, a practical risk prediction model for incident hypertension was successfully developed in a working-age Japanese male population.

DOI： 10.1038/hr.2014.159

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

© 2016 The Authors. Background: Hypertension is one of the main comorbidities associated with dyslipidemia. This study aimed to examine the extent to which dyslipidemia increases the risk of developing hypertension in a Japanese working-age male population. Methods and Results: We analyzed data from 14 215 nonhypertensive male workers (age 38±9 years) who underwent annual medical checkups. Subjects were followed up for a median of 4 years to determine new-onset hypertension, defined as blood pressure (BP) ≥140/90 mm Hg or use of antihypertensive medication. The associations between serum lipid levels and development of hypertension were examined. During the follow-up period, 1483 subjects developed hypertension. After adjusting for age, body mass index, impaired fasting glucose/diabetes, baseline BP category, alcohol intake, smoking, exercise, and parental history of hypertension, subjects with a total cholesterol (TC) level ≥222 mg/dL were at a significantly increased risk of developing hypertension (hazard ratio: 1.28; 95% CI: 1.06-1.56) compared to subjects with a TC level ≤167 mg/dL. Similar results were observed for subjects with high low-density lipoprotein cholesterol (LDLC) and non-high-density lipoprotein cholesterol (HDLC) levels. A U-shaped relationship was found between HDLC level and risk of hypertension; compared to the third quintile, the multiadjusted hazard ratio was 1.22 (95% CI: 1.03-1.43) in the lowest quintile and 1.34 (95% CI: 1.12-1.60) in the highest quintile. Conclusions: Elevated serum levels of TC, LDLC, and non-HDLC were associated with an increased risk of hypertension in working-age Japanese men. For HDLC, risk of hypertension was increased at both low and high levels.

DOI： 10.1161/JAHA.115.003053

Web of Science

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

Background: A slight elevation of cardiac troponin T (TnT) levels in the circulating blood can be detected by the recently developed, high-sensitivity TnT (hsTnT) assay. However, it remains unclear whether a slight elevation of hsTnT is associated with an increased cardiovascular risk in subjects without overt cardiovascular disease (CVD). Methods: The serum hsTnT levels were measured in a work site-based population of 1,072 middle-aged males (mean age 44 years) without any history or presence of CVD. The lower detection limit of the hsTnT assay used in the present study was 0.002 ng/mL. The association of the hsTnT levels with cardiovascular risk factors and the predicted CVD risk, as determined by the Framingham CVD risk prediction score, were examined. Results: Detectable hsTnT levels were seen in 867 subjects (80.9%). The highest value of the hsTnT was 0.020 ng/mL. Among various cardiovascular risk factors, age, blood pressure, estimated glomerular filtration rate, current smoking, and left ventricular hypertrophy were independent determinants of hsTnT levels. The odds ratio for a high predicted CVD risk (10-year risk ≥20%) in the highest tertile of hsTnT (≥0.005 ng/mL) in comparison to the lowest tertile (≤0.002 ng/mL) was 3.98 (95% CI 1.72-9.24, P = .001) after adjusting for multiple potential confounders. Conclusions: The present study showed the hsTnT levels to be significantly associated with several cardiovascular risk factors and the predicted CVD risk in middle-aged men without overt CVD, thus suggesting the usefulness of measuring hsTnT to identify high-risk subjects in the primary prevention of CVD. © 2010 Mosby, Inc. All rights reserved.

DOI： 10.1016/j.ahj.2010.02.036

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The extent of cardiac damage and its association with clinical outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for degenerative mitral regurgitation remains unclear. This study was aimed to investigate cardiac damage in patients with degenerative mitral regurgitation treated with TEER and its association with outcomes. METHODS: We analyzed patients with degenerative mitral regurgitation treated with TEER in the Optimized Catheter Valvular Intervention-Mitral registry, which is a prospective, multicenter observational data collection in Japan. The study subjects were classified according to the extent of cardiac damage at baseline: no extravalvular cardiac damage (stage 0), mild left ventricular or left atrial damage (stage 1), moderate left ventricular or left atrial damage (stage 2), or right heart damage (stage 3). Two-year mortality after TEER was compared using Kaplan-Meier analysis. RESULTS: Out of 579 study participants, 8 (1.4%) were classified as stage 0, 76 (13.1%) as stage 1, 319 (55.1%) as stage 2, and 176 (30.4%) as stage 3. Two-year survival was 100% in stage 0, 89.5% in stage 1, 78.9% in stage 2, and 75.3% in stage 3 (P=0.013). Compared with stage 0 to 1, stage 2 (hazard ratio, 3.34 [95% CI, 1.03-10.81]; P=0.044) and stage 3 (hazard ratio, 4.51 [95% CI, 1.37-14.85]; P=0.013) were associated with increased risk of 2-year mortality after TEER. Significant reductions in heart failure rehospitalization rate and New York Heart Association functional scale were observed following TEER (both, P<0.001), irrespective of the stage of cardiac damage. CONCLUSIONS: Advanced cardiac damage is associated with an increased risk of mortality in patients undergoing TEER for degenerative mitral regurgitation. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000023653.

DOI： 10.1161/CIRCINTERVENTIONS.123.013794

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Carotid intima-media thickness (IMT) measurement is used to assess subclinical atherosclerosis. We aimed to examine the association between the maximum IMT by location and the occurrence of silent brain infarction (SBI). METHODS: Overall, 280 Japanese individuals (92 females, 52.6±5 years old) underwent a medical check-up at our hospital in Tokyo in 2015. Carotid IMT was measured at each site on ultrasound images (common carotid artery [CCA], internal carotid artery, or bifurcation). The risk factors for arterial dysfunction were evaluated. SBI was assessed using magnetic resonance imaging (MRI). The cross-sectional relationship between carotid maximum IMT and SBI was evaluated. RESULTS: Of the 280 individuals, 18 (6.4%) were diagnosed with SBI on MRI. The mean age of the SBI(-) and SBI(+) groups was 51.9±10.6 and 63.6±18.6 years, respectively. The correlation coefficients between the carotid maximum IMT at each location were very weak (correlation coefficient range: 0.180-0.253). The percentage of participants with SBI increased significantly with increasing maximum CCA and bIMT values. After adjusting for confounders, SBI was found to be significantly associated with the maximum bIMT (per 0.1-mm increase) (adjusted odds ratio [aOR], 1.10; 95% confidence interval [CI]: 1.03-1.17). When bIMT was categorized according to three groups (＜1.0 mm, 1.0-＜2.0 mm, and ≥ 2.0 mm), a significant SBI risk was also observed with an increase by each category of bIMT (aOR: 3.96, 95% CI: 1.63-9.52, P=0.002). CONCLUSION: The maximum bIMT was found to be the main determinant of SBI. A significant SBI risk was associated with an increase in each category of the maximum bIMT. Therefore, the maximum bIMT might be a useful predictor of future stroke in Japanese stroke-free medical check-up participants.

DOI： 10.5551/jat.64721

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/jcm13030851

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.cct.2023.107358

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.cardfail.2023.10.476

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Limited data are available about clinical outcomes and residual mitral regurgitation (MR) after transcatheter edge-to-edge repair in the large Asian-Pacific cohort. Methods and Results From the Optimized Catheter Valvular Intervention (OCEAN-Mitral) registry, a total of 2150 patients (primary cause of 34.6%) undergoing transcatheter edge-to-edge repair were analyzed and classified into 3 groups according to the residual MR severity at discharge: MR 0+/1+, 2+, and 3+/4+. The mortality and heart failure hospitalization rates at 1 year were 12.3% and 15.0%, respectively. Both MR and symptomatic improvement were sustained at 1 year with MR ≤2+ in 94.1% of patients and New York Heart Association functional class I/II in 95.0% of patients. Compared with residual MR 0+/1+ (20.4%) at discharge, both residual MR 2+ (30.2%; P < 0.001) and 3+/4+ (32.4%; P = 0.007) were associated with the higher incidence of death or heart failure hospitalization (adjusted hazard ratio [HR], 1.59; P < 0.001, and adjusted HR, 1.73; P = 0.008). New York Heart Association class III/IV at 1 year was more common in the MR 3+/4+ group (20.0%) than in the MR 0+/1+ (4.6%; P < 0.001) and MR 2+ (6.4%; P < 0.001) groups, and the proportion of New York Heart Association class I is significantly higher in the MR 1+ group (57.8%) than in the MR 2+ group (48.3%; P = 0.02). Conclusions The OCEAN-Mitral registry demonstrated favorable clinical outcomes and sustained MR reduction at 1 year in patients undergoing transcatheter edge-to-edge repair. Both residual MR 2+ and 3+/4+ after transcatheter edge-to-edge repair at discharge were associated with worse clinical outcomes compared with residual MR 0+/1+. Registration Information https://upload.umin.ac.jp. Identifier: UMIN000023653.

DOI： 10.1161/JAHA.123.030747

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jns.2023.120797

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacasi.2023.06.008

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/s0140-6736(23)01142-x

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To investigate whether ultra-early recombinant tissue-plasminogen activator (rt-PA) administration can improve patient outcomes on mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO). METHODS: Participants comprised rt-PA-eligible 204 patients with internal carotid artery or middle cerebral artery occlusion in the SKIP trial, who were randomly assigned to receive mechanical thrombectomy alone or combined intravenous thrombolysis (rt-PA: alteplase at 0.6 mg/kg) plus mechanical thrombectomy. We assessed associations between onset-to-puncture time and onset-to-rt-PA administration time and frequency of favorable outcome at 90 days and any intracerebral hemorrhage (ICH) at 36 h after onset. RESULTS: As a cut-off onset-to-puncture time for favorable outcome, receiver operating characteristic curves defined 2.5 h (57% sensitivity, 62% specificity). For onset-to-puncture times ≤2.5 h and > 2.5 h, frequencies of favorable outcomes were 72% and 63% (p = 0.402) in patients with rt-PA therapy and 44% and 58% (p = 0.212) in patients without rt-PA therapy, respectively. In terms of onset-to-rt-PA administration time, frequencies of favorable outcomes among patients with ultra-early rt-PA administration at ≤100, >100 min after onset, and without rt-PA therapy with onset-to-puncture time ≤ 2.5 h, and with and without rt-PA therapy with onset-to-puncture time > 2.5 h were 84% and 64%, 63%, and 44% and 58%, respectively (p = 0.025). Frequencies of any ICH among those patients were 37% and 32%, 32%, and 63% and 40%, respectively (p = 0.006). CONCLUSION: Ultra-early rt-PA administration should improve patient outcomes on mechanical thrombectomy among patients with LVO. Relatively late rt-PA administration might increase the frequency of any ICH.

DOI： 10.1016/j.jns.2023.120772

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Recent studies suggested short-term mortality after transcatheter edge-to-edge repair (TEER) was comparable between men and women. However, the gender-specific prognostic difference in the long-term follow-up after TEER is still unknown. To evaluate the impact of gender on long-term mortality after TEER for functional mitral regurgitation (FMR) using multicenter registry data. We retrospectively analyzed 1,233 patients (male 60.3%) who underwent TEER for FMR at 24 centers. The impact of gender on all-cause death and hospitalization for heart failure (HF) after TEER was evaluated using multivariate regression analysis and propensity score (PS) matching methods. During the 2-year follow-up, 207 all-cause death and 263 hospitalizations for HF were observed after TEER for FMR. Men had a significantly higher incidence of all-cause death than women (18.6% vs 14.1%, log-rank p = 0.03). After adjustment by multivariate Cox regression and PS matching, the male gender was significantly associated with a higher incidence of all-cause mortality after TEER than the female gender (hazard ratio 2.11, 95% confidence interval 1.42 to 3.14 in multivariate Cox regression; hazard ratio 1.89, 95% confidence interval 1.03 to 3.48 in PS matching). The gender-specific prognostic difference was even more pronounced after 1-year of TEER. On the contrary, there was no gender-related difference in hospitalization for HF after TEER. In conclusion, women with FMR had a better prognosis after TEER than men, whereas this was not observed in hospitalization for HF. This result might indicate that women with FMR are more likely to benefit from TEER.

DOI： 10.1016/j.amjcard.2023.07.143

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jjcc.2023.01.001

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The effectiveness of long-term dual antiplatelet therapy (DAPT) to prevent recurrent strokes in patients with lacunar stroke remains unclarified. Therefore, this study aimed to compare and to elucidate the safety and effectiveness of DAPT and single antiplatelet therapy (SAPT) in preventing recurrence in chronic lacunar stroke. METHODS: CSPS.com (Cilostazol Stroke Prevention Study for Antiplatelet Combination) was a prospective, multicenter, randomized controlled trial. In this prespecified subanalysis, 925 patients (mean age, 69.5 years; 69.4% men) with lacunar stroke were selected from 1884 patients with high-risk noncardioembolic stroke, enrolled in the CSPS.com trial after 8 to 180 days following stroke. Patients were randomly assigned to receive either SAPT or DAPT using cilostazol and were followed for 0.5 to 3.5 years. The primary efficacy outcome was the first recurrence of ischemic stroke. The safety outcomes were severe or life-threatening bleeding. RESULTS: The DAPT group receiving cilostazol and either aspirin or clopidogrel and SAPT group receiving aspirin or clopidogrel alone comprised 464 (50.2%) and 461 (49.8%) patients, respectively. Ischemic stroke occurred in 12 of 464 patients (1.84 per 100 patient-years) in the DAPT group and 31 of 461 patients (4.42 per 100 patient-years) in the SAPT group, during follow-up. After adjusting for multiple potential confounding factors, ischemic stroke risk was significantly lower in the DAPT group than in the SAPT group (hazard ratio, 0.43 [95% CI, 0.22-0.84]). The rate of severe or life-threatening hemorrhage did not differ significantly between the groups (2 patients [0.31 per 100 patient-years] versus 6 patients [0.86 per 100 patient-years] in the DAPT and SAPT groups, respectively; hazard ratio, 0.36 [95% CI, 0.07-1.81]). CONCLUSIONS: In patients with lacunar stroke, DAPT using cilostazol had significant benefits in reducing recurrent ischemic stroke incidence compared with SAPT without increasing the risk of severe or life-threatening bleeding. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01995370. URL: https://www.umin.ac.jp/ctr; Unique identifier: UMIN000012180.

DOI： 10.1161/STROKEAHA.122.039900

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There are a few accurate predictors of patient outcomes after mechanical thrombectomy (MT). OBJECTIVE: To investigate whether the National Institutes of Health Stroke Scale (NIHSS) score 24 hours after stroke onset could predict favorable outcomes at 90 days in patients with acute stroke treated with MT. METHODS: Patients from the SKIP study were enrolled in this study. Using receiver operating characteristic curves, the optimal cut-off NIHSS score 24 hours after stroke onset was calculated to distinguish between favorable (modified Rankin Scale score 0-2) and unfavorable (modified Rankin Scale score 3-6) outcomes at 90 days. These receiver operating characteristic curves were compared with those of previously reported predictors of favorable outcomes, such as the ΔNIHSS score (baseline NIHSS score-NIHSS score at 24 h), percent delta (ΔNIHSS score × 100/baseline NIHSS score), and early neurological improvement indices. RESULTS: A total of 177 patients (median age, 72 years; female, 65 [37%]) were enrolled, and 109 (61.9%) had favorable outcomes. The respective sensitivity, specificity, and area under the curve values for an NIHSS of 10 were 92.6%, 80.7%, and .906; a ΔNIHSS score of 7 were 70.6%, 76.1%, and .797; and percent delta of 48.3% were 85.3%, 80.7%, and .890. CONCLUSION: NIHSS score <10 at 24 hours after stroke onset is a strong predictor of favorable outcomes at 90 days in patients treated with MT.

DOI： 10.1227/neu.0000000000002139

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Frailty is strongly associated with poor short- and long-term prognoses in patients who undergo transcatheter aortic valve implantation (TAVI). However, limited data are available regarding the association between frailty and late bleeding events after TAVI. Of the 2,518 patients in the Japanese multicenter TAVI registry, 1371 patients with complete data on frailty parameters were analyzed. We developed a modified Essential Frailty Toolset (EFT) using 4 frailty parameters-gait speed, Mini-Mental State Examination (MMSE), anemia, and hypoalbuminemia-that are significant predictors of late bleeding events in this cohort. The predictive value of the modified EFT for late bleeding after TAVI was assessed in comparison with other clinical variables. Late bleeding events after TAVI occurred in 80 patients (5.8%). Gait speed, MMSE, anemia, and hypoalbuminemia were significantly associated with late bleeding. A modified EFT was developed to include these parameters, which were scored from 0 to 5 points comprising the following 4 items: gait speed (0: >1.5 m/s, 1: 1.5 to 0.75 m/s, 2: <0.75 m/s), cognition (1: MMSE <18), anemia (1: hemoglobin <13 g/100 ml in men or <12 g/100 ml in women), and malnutrition (1: albumin <3.5 g/100 ml). Multivariate Cox regression analysis revealed that the modified EFT was an independent predictor of late bleeding (adjusted hazard ratio 1.51, 95% confidence interval [CI] 1.19 to 1.92, p <0.001) In conclusion, the modified EFT was found to be a significant predictive factor for late bleeding events after TAVI. Assessment of frailty is important to predict patients with high bleeding risk after TAVI.

DOI： 10.1016/j.amjcard.2022.08.024

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: TAS-102 improves overall survival (OS) of patients with refractory colorectal cancer (CRC), resulting in median progression-free survival (PFS) of 2.0 months (RECOURSE trial). Subsequently, a combination of TAS-102 and bevacizumab was shown to extend median PFS by 3.7 months. However, approximately half of these patients experience grade 3/4 neutropenia. In this study, we evaluated whether biweekly TAS-102 and bevacizumab therapy has efficacy equal to that of conventional TAS-102 and bevacizumab therapy and whether it reduces adverse hematological effects. METHODS: This phase II, investigator-initiated, open-label, single-arm, multicenter study was conducted in Japan. Eligible patients had previously received first- and second-line chemotherapy for metastatic CRC. TAS-102 (35 mg/m2) was given twice daily on days 1-5 and days 15-19 in a 4-week cycle, and bevacizumab (5 mg/kg) was administered by intravenous infusion for 30 min every 2 weeks. The primary end point was progression-free survival (PFS), and secondary end points were time-to-treatment failure (TTF), response rate (RR), OS, and safety. RESULTS: 44 patients with metastatic colorectal cancer were enrolled in this study. Median PFS was 4.6 months (95% confidence interval [95% CI] 3.6-5.3) and median OS was 10.5 months (95% CI 9.6-11.4). A partial response was observed in 2 patients (4.5%, 95% CI 0.4-16.0%). The most common adverse event above grade 3 was neutropenia (7 patients, 15.9%, 95% CI 7.6-29.7%). CONCLUSIONS: Biweekly TAS-102 and bevacizumab therapy as third-line chemotherapy appears as effective as conventional TAS-102 and bevacizumab therapy, and this approach reduces adverse hematological effects.

DOI： 10.1007/s10147-022-02243-4

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Principal investigators (PIs) play a key role in clinical research, and must thus understand the role of clinical research support staff to conduct successful and appropriate clinical research. This study evaluates clinical research capabilities by examining the clinical research knowledge of PIs and clinical research support staff. The participants of this cross-sectional study were academic researchers and clinical research support staff from Japanese universities and research institutions. The participants comprised of 54 respondents, among whom 36 were PIs (physicians) and 18 were clinical research support staff. A self-administered electronic survey was created and evaluated by experts, with 50 knowledge items. Mann-Whitney U tests were used to determine the significance of the differences in knowledge between clinical research support staff and PIs. We compared the correct answer rate of clinical research support staff and PIs for each knowledge category and observed that the clinical research support staff scored significantly higher than the PIs in all aspects of clinical research knowledge sections, including total score. Our findings showed that PIs did not have the same amount of clinical research knowledge as the clinical research support staff. Clinical research knowledge is essential for investigators, especially PIs, to protect patients and promote medical breakthroughs. Thus, more accessible clinical research education and mandatory knowledge testing will allow PIs to lead successful clinical research and further the level of medical research in Japan.

DOI： 10.1111/cts.13456

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To assess the inter methodological agreement of membrane septum (MS) length measurement and additive value for risk stratification of new pacemaker implantation (PMI) over the established predictors after transcatheter aortic valve replacement (TAVR). BACKGROUND: Recent studies have suggested MS length and implantation depth (ID) as predictors for PMI after TAVR. However, the measurement of MS length is neither uniform nor validated in different cohort. METHODS: We retrospectively analyzed patients who underwent TAVR at five centers. The MS length was measured by two previously proposed methods (coronal and annular view method). Predictive ability of risk factors, including MS length and ID, for new PMI within 30 days after TAVR were evaluated. RESULTS: Among 754 patients of study population, 31 patients (4.1%) required new PMI within 30 days of TAVR. There was a weak correlation (ρ = 0.47) and a poor agreement between the two methods. The ID and the difference between MS length and ID (ΔMSID), were independent predictors for new PMI, whereas MS length alone was not. Further, for predicting new PMI after TAVR, discrimination performance was not significantly improved when MS length was added to the model with ID alone (integrated discrimination improvement = 0, p= 0.99; continuous net-reclassification improvement = 0.10, p= 0.62). CONCLUSIONS: External validity and predictive accuracy of MS length for PMI after TAVR were not sufficient to provide better risk stratification over the established predictors in our cohort. Moreover, the ID and ΔMSID, but not MS length alone, are predictive of future PMI after TAVR.

DOI： 10.1002/ccd.30377

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Data regarding the incidence, predictive factors, and clinical outcomes of post-transcatheter aortic valve replacement (TAVR) bleeding is limited in the Asian cohort. OBJECTIVES: This study sought to assess the predictors and prognostic impact of post-TAVR late bleeding. METHODS: This study used the Japanese multicenter registry data to analyze 2,518 patients (mean age: 84.3 ± 5.2 years) who underwent TAVR. Late bleeding was defined as any postdischarge bleeding events after TAVR. Baseline characteristics, predictive factors, and clinical outcomes including death and rehospitalization were assessed in patients with and without late bleeding events. RESULTS: The cumulative incidence rate of all and major late bleeding and ischemic stroke were 7.4%, 5.2%, and 3.4%, respectively, 3 years after TAVR. The independent predictive factors of late bleeding were low platelet count, high score (≥4) on the clinical frailty scale, and a New York Heart Association functional class III/IV. The cumulative mortality rates up to 3 years were significantly higher in patients with late bleeding than in those without bleeding (P < 0.001). The multivariate Cox regression analysis revealed that late bleeding, included as a time-varying covariate in the model, was associated with an increased risk of mortality following TAVR (HR: 5.63; 95% CI: 4.28-7.41; P < 0.001). CONCLUSIONS: Late bleeding after TAVR was not a rare complication, and it significantly increased long-term mortality. It should be carefully managed, especially when it is predictable in the high-risk cohort, and efforts should be taken to reduce bleeding complications even after a successful procedure.

DOI： 10.1016/j.jacasi.2022.04.007

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Evidence on the association between ambient temperature and the onset of acute heart failure (AHF) is scarce and mixed. We sought to investigate the incidence of AHF admissions based on ambient temperature change, with particular interest in detecting the difference between AHF with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF). METHODS AND RESULTS: Individualized AHF admission data from January 2015 to December 2016 were obtained from a multicentre registry (Tokyo CCU Network Database). The primary event was the daily number of admissions. A linear regression model, using the lowest ambient temperature as the explanatory variable, was selected for the best-estimate model. We also applied the cubic spline model using five knots according to the percentiles of the distribution of the lowest ambient temperature. We divided the entire population into HFpEF + HFmrEF and HFrEF for comparison. In addition, the in-hospital treatment and mortality rates were obtained according to the interquartile ranges (IQRs) of the lowest ambient temperature (IQR1 <5.5°C; IQR25.5-13.3°C; IQR3 13.3-19.7°C; and IQR4 >19.7°C). The number of admissions for HFpEF, HFmrEF and HFrEF were 2736 (36%), 1539 (20%), and 3354 (44%), respectively. The lowest ambient temperature on the admission day was inversely correlated with the admission frequency for both HFpEF + HFmrEF and HFrEF patients, with a stronger correlation in patients with HFpEF + HFmrEF (R2  = 0.25 vs. 0.05, P < 0.001). In the sensitivity analysis, the decrease in the ambient temperature was associated with the greatest incremental increases in HFpEF, followed by HFmrEF and HFrEF patients (3.5% vs. 2.8% vs. 1.5% per -1°C, P < 0.001), with marked increase in admissions of hypertensive patients (systolic blood pressure >140 mmHg vs. 140-100 mmHg vs. <100 mmHg, 3.0% vs. 2.0% vs. 0.8% per -1°C, P for interaction <0.001). A mediator analysis indicated the presence of the mediator effect of systolic blood pressure. The in-hospital mortality rate (7.5%) did not significantly change according to ambient temperature (P = 0.62). CONCLUSIONS: Lower ambient temperature was associated with higher frequency of AHF admissions, and the effect was more pronounced in HFpEF and HFmrEF patients than in those with HFrEF.

DOI： 10.1002/ehf2.14010

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The benefit of adding ganglionated plexi ablation to the maze procedure remains controversial. This study aims to compare the outcomes of the maze procedure with and without ganglionated plexi ablation. METHODS: This multicenter randomized study included 74 patients with atrial fibrillation associated with structural heart disease. Patients were randomly allocated to the ganglionated plexi ablation group (maze with ganglionated plexi ablation) or the maze group (maze without ganglionated plexi ablation). The lesion sets in the maze procedure were unified in all patients. High-frequency stimulation was applied to clearly identify and perform ganglionated plexi ablation. Patients were followed up for at least 6 months. The primary endpoint was a recurrence of atrial fibrillation. RESULTS: The intention-to-treat analysis included 69 patients (34 in the ganglionated plexi ablation group and 35 in the maze group). No surgical mortality was observed in either group. After a mean follow-up period of 16.3 ± 7.9 months, 86.8% of patients in the ganglionated plexi ablation group and 91.4% of those in the maze group did not experience atrial fibrillation recurrence. Kaplan-Meier atrial fibrillation-free curves showed no significant difference between the two groups (P = .685). Cox proportional hazards regression analysis indicated that left atrial dimension was the only risk factor for atrial fibrillation recurrence (hazard ratio: 1.106, 95% confidence interval 1.017-1.024, P = .019). CONCLUSION: The addition of ganglionated plexi ablation to the maze procedure does not improve early outcome when treating atrial fibrillation associated with structural heart disease.

DOI： 10.1007/s11748-022-01820-8

PubMed

researchmap

記述言語：英語  

DOI： 10.1007/s12149-021-01707-3

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Myocardial ischemia is known to suppress fatty acid metabolism and favor glucose metabolism. However, changes in myocardial metabolism after coronary revascularization are not fully elucidated. METHODS: Thirty-eight patients with coronary artery disease were retrospectively enrolled. These patients had undergone stress perfusion single photon emission computed tomography (SPECT) and 123I-BMIPP SPECT in both the short-term (6.4 ± 4.7 months) and mid-term (29.9 ± 7.2 months) after isolated coronary artery bypass grafting. Tracer uptake was graded using a 17-segment, 5-point scoring model. Serial changes in SRS (summed rest score), SDS (summed difference score), the BMIPP score (total defect score of BMIPP), and the mismatch score (BMIPP score-SRS) were evaluated. In addition, persistent perfusion-metabolism mismatch (PM) was defined as mismatch score minus SDS of 3 or more during the mid-term postoperative period. The clinical parameters associated with PM were examined. RESULTS: From short- to mid-term postoperative period, the extent of infarcted myocardium (SRS) did not change significantly (7.8 ± 8.0 to 7.1 ± 7.0, P = 0.117). The extent of ischemic myocardium (SDS), the BMIPP score and the mismatch score, which reflects perfusion-metabolism mismatch, were significantly improved (2.0 ± 2.8 to 0.7 ± 1.0, P = 0.010; 12.2 ± 9.0 to 9.5 ± 7.9, P < 0.001; 4.4 ± 3.7 to 2.5 ± 2.6, P < 0.001; respectively). Remarkably, perfusion-metabolism mismatch persisted in 13 patients (34%) even in the mid-term postoperative period. eGFR and SYNTAX score were independent predictors of persistent perfusion-metabolic mismatch in multivariable analysis (OR = 0.951, 95% CI 0.898-0.985, P = 0.010 and OR = 1.126, 95% CI 1.011-1.254, P = 0.031, respectively). The mismatch score both in the short- and mid-term significantly correlated with SYNTAX score (r = 0.400 and r = 0.472, respectively). CONCLUSIONS: Fatty acid metabolism disturbance improved from short- to mid-term postoperative period in patients with successful reperfusion by coronary artery bypass grafting. However, in patients with severe atherosclerosis, impaired fatty acid metabolism was sustained until the mid-term postoperative period, even though ischemia had resolved.

DOI： 10.1007/s12149-021-01696-3

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We investigated whether intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) was associated with favourable neurological outcomes for patients after the return of spontaneous circulation (ROSC). Moreover, we evaluated the aetiology of cardiac arrest on the effectiveness of this therapy in a sub-study. BACKGROUND: There is insufficient research on the optimal combination of machines for patients after ROSC is not established. METHODS: This is a large-scale, multicentre, 30-day cohort study. Among 80,716 patients who delivered to the emergency room, 935 patients treated with VA-ECMO after ROSC were included using the data from the Tokyo Cardiovascular Care Unit Network Registry between 2010 and 2017. The study patients were stratified according to the use of IABP [the ECMO + IABP group (n = 762) vs. the ECMO-alone group (n = 173)]. We also evaluated the cause of cardiac arrest [acute coronary syndrome (ACS) and non-ACS] in the sub-study. To adjust the patients' backgrounds, we used the propensity score matching for additional analyses. The endpoint was 30-day favourable neurological outcome. RESULTS: The ECMO + IABP group showed significantly better neurological outcomes than the ECMO-alone group (crude; 35% vs. 25%; log-lank P < 0.001). In the ACS subgroup, the ECMO + IABP group showed significantly better neurological outcome (crude; 34% vs. 18%; log-lank P < 0.001), but not in the non-ACS subgroup (crude; 38% vs. 32%; log-lank P = 0.11). These results are similar after adjustments to their backgrounds using propensity matching. CONCLUSIONS: Compared to VA-ECMO alone, the combined use of VA-ECMO and IABP is associated with better neurological outcomes after ROSC, especially in complicated ACS.

DOI： 10.1016/j.resuscitation.2021.07.019

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: The aim of the present study was to consider whether the ultrastructural features of cardiomyocytes in dilated cardiomyopathy can be used to guide genetic testing. METHODS AND RESULTS: Endomyocardial biopsy and whole-exome sequencing were performed in 32 consecutive sporadic dilated cardiomyopathy patients [51.0 (40.0-64.0) years, 75% men] in initial phases of decompensated heart failure. The predicted pathogenicity of ultrarare (minor allele frequency ≤0.0005), non-synonymous variants was determined using the American College of Medical Genetics guidelines. Focusing on 75 cardiomyopathy-susceptibility and 41 arrhythmia-susceptibility genes, we identified 404 gene variants, of which 15 were considered pathogenic or likely pathogenic in 14 patients (44% of 32). There were five sarcomeric gene variants (29% of 17 variants) found in five patients (16% of 32), involving a variant of MYBPC3 and four variants of TTN. A patient with an MYBPC3 variant showed disorganized sarcomeres, three patients with TTN variants located in the region encoding the A-band domain showed sparse sarcomeres, and a patient with a TTN variant in encoding the I-band domain showed disrupted sarcomeres. The distribution of diffuse myofilament lysis depended on the causal genes; three patients with the same TMEM43 variant had diffuse myofilament lysis near nuclei (P = 0.011), while two patients with different DSP variants had lysis in the peripheral areas of cardiomyocytes (P = 0.033). CONCLUSIONS: Derangement patterns of myofilament and subcellular distribution of myofilament lysis might implicate causal genes. Large-scale studies are required to confirm whether these ultrastructural findings are related to the causative genes.

DOI： 10.1002/ehf2.13596

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: An ideal urban network system for improving regional acute myocardial infarction (AMI) outcomes should be geographically balanced and uniform according to regional population in performance of participating hospitals. The objective of our study is to evaluate whether there is a major difference in risk-adjusted in-hospital mortality between the Tokyo Cardiovascular Care Unit (CCU) network hospitals, which cover the whole population of large cities. METHODS: The study subjects were all AMI patients without cardiac arrest on arrival admitted to the Tokyo CCU network hospitals from 2009 to 2017. Risk-adjusted in-hospital mortality rates (RAMRs) were compared between the categories of each hospital-level factor. A hospital-level multivariable linear regression was modeled to analyze the association between RAMRs and hospital-level factors. A funnel plot was constructed by plotting RAMRs against hospital volumes. RESULTS: From 2009 to 2017, there were 42,123 hospitalizations for AMI in Tokyo CCU network hospitals (n=72, as of December, 2017). There were no significant differences in RAMRs in the comparison of hospital backgrounds. Each hospital background was not significantly associated with the RAMR. Considering the 99% CI in funnel plots, only five hospitals (7.2%) were located outside the control limits. CONCLUSIONS: There was no major difference in the RAMRs between the participating hospitals within the Tokyo CCU network, despite the different hospital backgrounds.

DOI： 10.1016/j.jjcc.2021.04.002

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: This study investigated the prognostic value of plasma volume status (PVS) in patients who underwent transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: Plasma volume status was calculated in 2588 patients who underwent TAVR using data from the Japanese multicentre registry. All-cause mortality and heart failure hospitalization (HFH) within 2 years of TAVR were compared among the PVS quartiles (Q1, PVS < 5.5%; Q2, PVS 5.5-13.5%; Q3, PVS 13.5-21.0%; and Q4, PVS ≥ 21.0%). Subgroups were stratified by the PVS cut-off value combined with the New York Heart Association (NYHA) class as follows: low PVS with NYHA I/II (n = 959), low PVS with NYHA III/IV (n = 845), high PVS with NYHA I/II (n = 308), and high PVS with NYHA III/IV (n = 476). The cumulative all-cause mortality and HFH within 2 years of TAVR significantly increased with increasing PVS quartiles [8.5%, 16.8%, 19.2%, and 27.0% (P < 0.001) and 5.8%, 8.7%, 10.3%, and 12.9% (P < 0.001), respectively]. The high-PVS group regardless of the NYHA class had a higher all-cause mortality and HFH [9.6%, 18.2%, 24.5%, and 30.4% (P < 0.001) and 6.1%, 10.4%, 14.1%, and 11.3% (P < 0.001)]. In a Cox regression multivariate analysis, the PVS values of Q3 and Q4 had independently increased all-cause mortality [hazard ratio (HR), 1.50 and 1.64 (P = 0.017 and P = 0.008), respectively], and Q4 had independently increased HFH (HR, 1.98, P = 0.005). The low PVS with NYHA III/IV, high PVS with NYHA I/II, and high PVS with NYHA III/IV also had significantly increased all-cause mortality [HR, 1.45, 1.73, and 1.86 (P = 0.006, P = 0.002, and P < 0.001), respectively] and HFH [HR, 1.52, 2.21, and 1.70 (P = 0.049, P = 0.002, and P = 0.031), respectively]. CONCLUSIONS: Plasma volume status is useful for predicting all-cause mortality and HFH after TAVR.

DOI： 10.1002/ehf2.13270

PubMed

researchmap

記述言語：英語  

DOI： 10.1001/jama.2021.4037

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study aimed to explore the flow dynamics factors affecting turbulence formation in the false lumen (FL) of aortic dissection using four-dimensional flow magnetic resonance imaging (4D flow MRI). This study also aimed to uncover risk factors affecting late complications of aortic dissection. METHODS: Thirty-three aortic dissection patients were examined using 4D flow MRI for quantitative flow dynamics (gross flow, velocity and regurgitant fraction) and turbulence visualization (helix and vortex with three-point visual grading) in the FL. The incidence of late complications (rupture or prophylactic intervention) was also obtained prospectively. RESULTS: The helix grade was correlated with FL gross flow (rS = 0.55, P < 0.001) and FL velocity (rS = 0.45, P = 0.008). The vortex grade was also correlated with FL gross flow (rS = 0.70, P < 0.001) and FL velocity (rS = 0.67, P < 0.001). Comparative analysis of patients with complications and stable patients revealed that patients with complications exhibited higher FL gross flow [41.7 (interquartile range, IQR 29.1-59.7) vs 17.7 (IQR 9.0-42.0) ml/s; P = 0.01], higher helix grade [2 (IQR 1.25-2) vs 0 (IQR 0-1); P = 0.001] and higher vortex grade [2 (IQR 1-2) vs 0 (IQR 0-2); P = 0.01]. CONCLUSIONS: Using 4D flow MRI analysis, we showed that turbulence formation depends on flow volume and velocity in the FL. Patients with high-volume turbulent flow in their FL are at higher risk of late complications; therefore, close follow-up and aggressive prophylactic intervention may improve their survival. CLINICAL TRIAL REGISTRATION NUMBER: Nippon Medical School Hospital Institutional Review Board approved this observational study in September 2018 (No. 30-08-986).

DOI： 10.1093/ejcts/ezab201

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Several factors determining differences between types A and B aortic dissection (AD) have been reported; however, little data exist examining their differences in left ventricular hypertrophy (LVH). We compared the prevalence of LVH in patients with types A and B AD. METHODS: We retrospectively analyzed 334 patients with acute AD (227 type A; 107 type B). Concentric hypertrophy (CH; increased left ventricular mass index [LVMI] and relative wall thickness [RWT]) is one of four types of left ventricular (LV) geometry thought to be most associated with hypertension. We compared LVMI and the prevalence of CH in patients with types A or B AD. Multivariate logistic regression analyses of variables associated with type B AD were performed. RESULTS: Comparing type A and B AD, LVMI (95 ± 26 vs.107 ± 28, p <0.001) and prevalence of CH (26% vs. 44%, p = 0.001) were higher in type B AD. In multivariate analysis, CH was an independent factor associated with type B AD (odds ratio: 2.62, confidence interval: 1.54-4.47, p <0.001). CONCLUSIONS: Our data suggested LVH was more prevalent in type B than in type A AD. Considering LVH usually results from hypertension, patients with type B AD may be more affected by hypertension than those with type A.

DOI： 10.5761/atcs.oa.20-00137

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Information on early to late-phase kidney damage in patients who underwent transcatheter aortic valve replacement (TAVR) is scarce. We aimed to identify the predictive factors for late kidney injury (LKI) at 1-year and patient prognosis beyond 1-year after TAVR. METHODS: We retrospectively reviewed 1,705 patients' data from the Japanese TAVR multicenter registry. Acute kidney injury (AKI) and LKI, defined as an increase of at least 0.3 mg/dL in creatinine level, a relative 50% decrease in kidney function from baseline to 48 hours and 1-year, were evaluated. The patients were categorized into the 4 groups as AKI-/LKI- (n = 1.362), AKI+/LKI- (n = 95), AKI-/LKI+ (n = 199), and AKI+/LKI+ (n = 46). RESULTS: The cumulative 3-year mortality rates were significantly increased across the four groups (12.5%, 15.8%, 24.6%, 25.8%, P < .001). Multivariate analysis revealed that chronic kidney disease, coronary artery disease, periprocedural AKI, and heart failure-related re-admission within 1-year were significantly associated with LKI. The Cox regression analysis revealed that AKI-/LKI+ and AKI+/LKI+ were independent predictors of increased late mortality beyond 1-year after TAVR (P = .001 and P = .01). CONCLUSIONS: LKI was influenced by adverse cardio-renal events and was associated with increased risks of late mortality beyond 1-year after TAVR.

DOI： 10.1016/j.ahj.2021.01.007

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: An inter-arm difference in blood pressure (IADBP) is characteristic of acute aortic dissection (AAD), but which arm shows lower blood pressure (BP) and the mechanism of IADBP has not been fully elucidatedMethods: We identified consecutive patients with chest and/or back pain and suspected acute cardiovascular disease whose BP had been measured in both arms. We retrospectively compared the characteristics of such patients with AAD (n=93) to those without (non-AAD group, n=122). Additionally, we separately compared patients with type A AAD (TAAD group, n=58) or type B AAD (TBAD group, n=35) to non-AAD group. Characteristics included in these comparisons were patients' backgrounds and IADBP-related factors such as systolic BP (SBP) in the right arm (R) and left arm (L), R-L or L-R as the IADBP. Computed tomography (CT) findings of AD extending to the brachiocephalic artery (BCA) and/or left subclavian artery (LSCA) were examined in patients having IADBP. RESULTS: In the TAAD group, the prevalence of R<130mmHg (38%-vs.-19%, p=0.009), L-R>15mmHg (19%-vs.-8%, p=0.047), L-R>20mmHg (14%-vs.-4%, p=0.029) was higher than in the non-AAD group. Multivariate analysis showed L-R>15mmHg with R<130mmHg was independently associated with TAAD (OR 25.97, 95% CI 2.45-275.67, p=0.007). However, IADBP-related factors were not associated with TBAD. AAD patients with L-R>20mmHg were all TAAD, and all aortic dissection extended to BCA just before the right common carotid artery on CT. CONCLUSIONS: IADBP was characterized by R<L with low R in TAAD, but was not associated with TBAD.

DOI： 10.1272/jnms.JNMS.2021_88-605

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The purpose of this study was to conduct a factual survey to evaluate the type of clinical research support offered by service providers (supporters) in Japanese academic research organizations (AROs). From September to October 2018, we conducted an online questionnaire targeting researchers and supporters of AROs, including individuals supporting research and development (R&D) planning, as well as those involved in study management, biostatistics, coordination, data management, monitoring, and auditing. The number of responses was tabulated for each survey item. For items with written descriptions, we compiled summaries using the inductive regression method of qualitative research. Responses were obtained from 124 researchers, 258 supporters, and 40 AROs. None of the institutions responded that they had a performance index for all types of service providers, whereas 47% of institutions had an index for 1-3 types of service providers, and 40% of institutions had no index. Many institutions responded that they had a performance index for coordinators and data management, but few responded that there was a performance index for individuals engaged in R&D and study management. Furthermore, for all evaluations of AROs and researchers, the level of supporter satisfaction was low at only 20%. There was a discrepancy between the levels of researcher expectations and the actual contribution of R&D in the process of research planning. Our survey revealed that there is currently no performance index for services supporting clinical research. In future studies, we need to examine a performance index that accurately reflects the researcher attitudes revealed in this study.

DOI： 10.1111/cts.12942

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Blood pressure (BP) variability has reportedly been a risk factor for various clinical events. To clarify the influence of BP visit-to-visit variability on adverse events in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J-RHYTHM Registry was performed. Methods and Results Of 7406 outpatients with nonvalvular atrial fibrillation from 158 institutions, 7226 (age, 69.7±9.9 years; men, 70.7%), in whom BP was measured 4 times or more (14.6±5.0 times) during the 2-year follow-up period or until occurrence of an event, constituted the study group. SD and coefficient of variation of BP values were calculated as BP variability. Thromboembolism, major hemorrhage, and all-cause death occurred in 110 (1.5%), 121 (1.7%), and 168 (2.3%) patients, respectively. When patients were divided into quartiles of systolic BP-SD (<8.20, 8.20-10.49, 10.50-13.19, and ≥13.20 mm Hg), hazard ratios (HRs) for all adverse events were significantly high in the highest quartile compared with the lowest quartile (HR, 2.00, 95% CI, 1.15-3.49, P=0.015 for thromboembolism; HR, 2.60, 95% CI, 1.36-4.97, P=0.004 for major hemorrhage; and HR, 1.85, 95% CI, 1.11-3.07, P=0.018 for all-cause death) after adjusting for components of the CHA2DS2-VASc score, warfarin and antiplatelet use, atrial fibrillation type, BP measurement times, and others. These findings were consistent when BP-coefficient of variation was used instead of BP-SD. Conclusions Systolic BP visit-to-visit variability was significantly associated with all adverse events in patients with nonvalvular atrial fibrillation. Further studies are needed to clarify the causality between BP variability and adverse outcomes in patients with nonvalvular atrial fibrillation. Registration URL: https://www.umin.ac.jp/ctr/; Unique Identifier: UMIN000001569.

DOI： 10.1161/JAHA.120.018585

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patients admitted on weekends have higher mortality than those admitted on weekdays. However, whether the "weekend effect" results in a higher mortality after admission for acute aortic dissection (AAD),-classified according to Stanford types-remains unclear. This study aimed to examine the association between admission day and in-hospital mortality in AAD Type A and B. METHODS: We used data from the Japanese registry of all Cardiac and Vascular Diseases Diagnostic Procedure Combination, a nationwide claim-based database with data from 953 certified hospitals, and enrolled in-patients with AAD admitted between April 1, 2012, and March 31, 2016. Based on the admission day, we stratified patients into groups (Weekdays, Saturdays, and Sundays/holidays). The influence of the admission day on in-hospital mortality was assessed via multi-level logistic regression analysis. We also performed a Stanford type-based stratified analysis. RESULTS: Among the included 25,641 patients, in-hospital mortality was 16.0%. The prevalence of patients admitted with AAD was relatively higher on weekdays. After adjustment for covariates, patients admitted on a Sunday/holiday showed an increased risk of in-hospital mortality (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.07-1.33, p<0.001) than patients admitted on weekdays. Among patients admitted on a Sunday/holiday, only the subgroup of Stanford Type A showed a significantly increased risk of in-hospital mortality. (Stanford Type A, non-surgery vs. surgery groups: 95% CI 1.06-1.48 vs. 1.17-1.68, p<0.001 for both groups, OR 1.25 vs. 1.41, respectively, Stanford Type B, non-surgery vs. surgery groups: 95% CI 0.64-1.09 vs. 0.40-2.10; p = 0.182 vs. 0.846; OR 0.84 vs. 0.92). CONCLUSIONS: In conclusion, patients with AAD Type A admitted on a Sunday/holiday may have an increased in-hospital mortality risk.

DOI： 10.1371/journal.pone.0260152

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2020 Elsevier Inc. Data regarding the longitudinal effect of catheter procedure-related acute kidney injury (AKI) on clinical outcomes are limited. This study aimed to assess the late adverse cardiorenal events of AKI following transcatheter aortic valve implantation (TAVI). A total of 2,518 patients who underwent TAVI, excluding in-hospital deaths, were enrolled from the Japanese multicenter registry. The definition of AKI was determined using the Valve Academic Research Consortium-2 criteria. The incidence, predictors, major adverse renal and cardiac events (MARCE), and all-cause mortality of AKI were evaluated. MARCE included readmission for renal and heart failure (HF), hemodialysis requirement, and cardiovascular-renal death during the follow-up period. The incidence of AKI was 9.7% in the entire cohort. The significant predictive factors of AKI were men, diabetes mellitus, hypertension, chronic kidney disease, low albumin, overdose of contrast media, nontransfemoral approach, transfusion, vascular complications, and new pacemaker implantation. The rates of HF readmission and future hemodialysis were significantly higher in patients with AKI than in those without AKI (19.7% vs 9.0%, p <0.001, 3.3% vs 0.4%, p <0.001, respectively). Cox regression multivariate analysis showed that AKI occurrence was an independent predictive factor for the incremental risk of both MARCE and late mortality up to 4 years (hazard ratio [HR] 1.59, 95% confidence interval [CI] 0.75 to 1.20, p <0.001, HR 2.18, 95% CI 1.70 to 2.79; p <0.001, respectively). In conclusion, AKI occurrence was significantly associated with late adverse cardiorenal events after TAVI. Adequate clinical management can be expected to reduce AKI-related late phase cardiorenal damage even after successful TAVI.

DOI： 10.1016/j.amjcard.2020.07.041

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The prognostic impact of hyperuricemia and the factors that induce hyperuricemia in cardiovascular intensive care patients remain unclear. METHODS AND RESULTS: A total of 3257 emergency department patients were screened, and data for 2435 patients who were admitted to an intensive care unit were analyzed. The serum uric acid level was measured within 15 min of admission. The patients were assigned to a low-uric acid group (uric acid ⩽7.0 mg/dl, n=1595) or a high-uric acid group (uric acid >7.0 mg/dl, n=840) according to their uric acid level on admission. Thereafter, the patients were divided into four groups according to the quartiles of their serum uric acid level (Q1, Q2, Q3 and Q4), and uric acid levels and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. A Kaplan-Meier curve showed a significantly lower 365-day survival rate in a high-uric acid group than in a low-uric acid group, and in Q3 than in Q1 or Q2 and in Q4 than in the other groups. The multivariate logistic regression model for 30-day mortality identified Q4 (odds ratio: 1.856, 95% confidence interval (CI) 1.140-3.022; p=0.013) as an independent predictor of 30-day mortality. The area under the receiver-operating characteristic curve values of the serum uric acid level and APACHE II score for the prediction of 30-day mortality were 0.648 and 0.800, respectively. The category-free net reclassification improvement and integrated discrimination improvement showed that the calculated risk shifted to the correct direction by adding the serum uric acid level to the APACHE II score (0.204, 95% CI 0.065-0.344; p=0.004, and 0.015, 95% CI 0.005-0.025; p=0.004, respectively). The prognosis, including the 365-day mortality, among patients with a high uric acid level and a high APACHE II score was significantly poorer in comparison with other patients. CONCLUSION: The serum uric acid level, which might be elevated by the various critical stimuli on admission, was an independent predictor in patients who were emergently hospitalized in the intensive care unit. The serum uric acid level is therefore useful as a surrogate biomarker for critical patients in the intensive care unit.

DOI： 10.1177/2048872618822473

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2020 Elsevier B.V. Background: The cardio-ankle vascular index (CAVI) has been proposed as a useful parameter for arteriosclerotic diseases. However, whether it is associated with stroke risk in Japanese subjects remains unclear. Methods: In total, 280 Japanese subjects (92 females, 52.6 ± 5 years old) underwent a medical check-up. CAVI value and risk factors for arterial dysfunction were evaluated; the predicted 10-year stroke risk was measured by the Japan Public Health Center study. Results: Age, sex, body mass index, and systolic blood pressure were significant independent predictors of CAVI. CAVI values were significantly elevated in the high, compared with the medium-low and low predicted risk groups. A significant odds ratio (OR) for the high-risk group was noted in the highest quartile of CAVI values (OR, 14.67; 95% confidence interval [CI], 3.17–68.0), compared with the lowest quartile, after adjusting for potential confounders. A significant OR for very high predicted stroke risk was also found for each quartile increase (OR, 3.04; 95% CI, 1.87–4.94) and 1-standard deviation increase (OR, 2.24; 95% CI, 1.52–3.30) in CAVI value. Conclusion: Elevated CAVI values were related to an elevated predicted stroke risk, suggesting that CAVI could be a suitable surrogate marker for finding subjects at an increased risk of first-ever stroke.

DOI： 10.1016/j.jns.2020.116862

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2020, Springer Nature B.V. Skeletal muscle mass (SMM) as calculated by computed tomography (CT) is a predictor of all-cause mortality after transcatheter aortic valve replacement (TAVR), but it remains unclear whether using CT-determined density of skeletal muscle has additive prognostic value. We utilized the Japanese multicenter registry data of 1375 patients who underwent CT prior to TAVR. Sarcopenia status was defined by the CT-derived SMM index (threshold: men, 55.4 cm2/m2; women, 38.9 cm2/m2). The threshold for high and low CT density was based on the median value of the entire cohort (men: 33.4 HU; women: 29.5 HU). Sarcopenia was observed in 802 patients (58.3%) overall. Patients were categorized into non-sarcopenia and high-CT density (n = 298), non-sarcopenia and low-CT density (n = 275), sarcopenia and high-CT density (n = 399), and sarcopenia and low-CT density (n = 403) groups, and procedural outcomes and mortality compared. The cumulative 3-year mortality rates in these groups were 18%, 27%, 24%, and 32%, respectively. Cox-regression multivariate analysis revealed that low-CT density (compared with high-CT density) and sarcopenia and low-CT density (compared with non-sarcopenia and high-CT density as reference) increased mortality after TAVR (hazard ratios [HR]: 1.35 and 1.43, 95% confidence intervals [Cis]: 1.06–1.72 and 1.00–2.08, p = 0.01, and 0.049, respectively). However, sarcopenia alone was not related to an increased risk of mortality (HR 1.30, 95% CI 0.99–1.69, p = 0.52). In conclusion, CT density-based skeletal muscle quality assessment combined with the SMM index improves prediction of adverse outcomes after TAVR.

DOI： 10.1007/s10554-020-01776-x

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2020 Elsevier Inc. Background: Little is known about changes in nutritional status as an index of frailty on clinical outcomes after transcatheter aortic valve replacement (TAVR). This study aimed to assess the clinical impact of serum albumin changes after TAVR. Methods: Changes in serum albumin levels from baseline to 1 year after TAVR were evaluated in 1524 patients who were classified as having hypoalbuminemia (<3.5 g/dl) and normoalbuminemia (≥3.5 g/dl) at each timepoint. The patients were categorized into 4 groups: NN (baseline normoalbuminemia, 1-year normoalbuminemia: n = 1119), HN (baseline hypoalbuminemia, 1-year normoalbuminemia: n = 202), NH (baseline normoalbuminemia, 1-year hypoalbuminemia: n = 121), and HH (baseline hypoalbuminemia, 1-year hypoalbuminemia: n = 82). We also defined late hypoalbuminemia as hypoalbuminemia identified at the 1-year assessment. Clinical outcomes were compared among 4 groups. Multivariable analysis was driven to assess the variables associated with late hypoalbuminemia and long-term mortality. Results: The cumulative 3-year mortality was significantly different among the 4 groups (NN: 11.4%, HN: 10.7%, NH: 25.4%, HH: 44.4%, p < 0.001). Multivariable Cox regression analysis revealed that the NH group had a higher mortality risk (hazard ratio [HR]; 2.80 and 3.53, 95% confidence interval [CI]; 1.71–4.57 and 2.06–6.06, p < 0.001 and p < 0.001, respectively), whereas the HN group had a similar risk (HR; 1.16, 95% CI; 0.66–2.06, p = 0.61) compared with the NN group. Baseline hypoalbuminemia, low body mass index, liver disease, peripheral artery disease, and hospital readmission within 1 year were predictors of late hypoalbuminemia (all p < 0.05). Conclusion: Serial albumin assessment may identify poor prognostic subsets in patients with persistent and late acquired malnutrition after TAVR.

DOI： 10.1016/j.carrev.2020.08.031

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

© 2020 Elsevier B.V. Background: Existing studies have yielded conflicting results regarding the relationship between the time of occurrence of out-of-hospital cardiac arrests and the associated outcomes. We examined whether the one-month survival rate for out-of-hospital cardiac arrests differed depending on whether the cardiac arrest occurred during the day or night. Further, we examined whether this rate differed when comparing the period succeeding the 2005 International Resuscitation Guidelines (2006–2010) with that following the 2010 guidelines (2011–2015). Method: Using data from the All-Japan Utstein Registry for 2006–2015, adult out-of-hospital cardiac arrest patients whose collapse was witnessed and for whom the collapse-to-hospital-arrival interval was shorter than 120 min were included in this study. Patients were categorized in terms of whether their arrest occurred during the post-2005- or post-2010-guideline period. The primary measure was the one-month survival with a favorable neurological outcome. Results: Of 481,624 cases analyzed, 20% occurred at night. For both guideline periods, nighttime out-of-hospital cardiac arrests were associated with significantly lower one-month survival rates than daytime incidents (used as a reference; adjusted odds ratio: 0.69 and 0.63, 95% confidence interval: 0.65–0.73 and 0.60–0.65, and P < 0.001 and <0.001 for the 2005 and 2010 guideline periods, respectively). Conclusions: One-month survival with a favorable neurological outcome was significantly lower for patients who experienced nighttime out-of-hospital cardiac arrests, compared to daytime out-of-hospital cardiac arrests. This could be addressed by improving cardiopulmonary resuscitation training for bystanders and expanding and improving nighttime emergency medical services.

DOI： 10.1016/j.ijcard.2020.09.043

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University Background and aims: Peripheral artery disease (PAD), intermittent claudication, and impaired mobility contribute to the loss of skeletal muscle. This study investigated the impact of endovascular treatment (EVT) in patients suffering from PAD above the knee and its relation to baseline glycemic control. Methods and results: Mid-thigh muscle volume was measured before EVT, 3 months after EVT and 6 months after EVT. Mid-thigh muscle volumes of ipsilateral PAD patients with ischemic and non-ischemic legs were compared. Correlations between total thigh muscle volume and clinical characteristics were analyzed using univariable and multivariable analysis. Overall, thigh muscle volume increased after EVT. The mid-thigh muscle volume was significantly lower in patients with ipsilateral lesions and in those with ischemic lower limbs. The thigh muscle volume of those with ischemic lower limbs increased after EVT. Baseline glycated hemoglobin was the only factor that was negatively correlated with changes in the muscle volume after EVT. Muscle volume significantly increased in normoglycemic HbA1c<6.5% (47 mmol/mol) patients. There was no significant alteration in the muscle volume of hyperglycemic HbA1c ≥ 6.5% patients. Conclusion: Ischemic muscle atrophy was ameliorated after EVT in normoglycemic patients. There is a need for a large-scale trial to investigate whether EVT can protect or delay skeletal muscle loss.

DOI： 10.1016/j.numecd.2020.09.003

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

© 2020, Japan Society of Clinical Oncology. Background: TAS-102 improved the overall survival of metastatic colorectal cancer (CRC) patients with a median progression-free survival (PFS) in the RECOURSE trial. Subsequently, the combination of TAS-102 and bevacizumab was shown to extend the median PFS (C-TASK FORCE study). However, the study included patients who received second- and third-line treatment. Our study exclusively examined patients receiving this combination as a third-line treatment to investigate the clinical impact beyond cytotoxic doublets. Methods: This investigator-initiated, open-label, single-arm, multi-centered phase II study was conducted in Japan. Eligible CRC patients were refractory or intolerant to fluoropyrimidine, irinotecan, and oxaliplatin in first- and second-line therapy. TAS-102 (35 mg/m2) was given orally twice daily on days 1–5 and 8–12 in a 4-week cycle, and bevacizumab (5 mg/kg) was administered by intravenous infusion every 2 weeks. The primary endpoint was PFS and the secondary endpoints were time-to-treatment failure, response rate, overall survival (OS), and safety. Results: Between June 2016 and August 2017, 32 patients were enrolled. All patients previously received bevacizumab. The median PFS was 4.5 months; the median overall survival was 9.3 months. Partial response was observed in two patients. The most common adverse events above grade 3 were neutropenia followed by thrombocytopenia. There were no non-hematological adverse events above grade 3 and no treatment-related deaths occurred. Conclusions: This study met its primary endpoint of PFS, which is comparable to the results of the C-TASK FORCE study. The TAS-102 and bevacizumab combination has the potential to be a therapeutic option for third-line treatment of metastatic CRC.

DOI： 10.1007/s10147-020-01794-8

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

J-GLOBAL

researchmap

掲載種別：研究論文（学術雑誌）  

© 2019 Japanese College of Cardiology Background: Catheter ablation (CA) has been reported to reduce risk of stroke in patients with nonvalvular atrial fibrillation (NVAF) in retrospective studies. However, the risks and benefits of CA have not been well elucidated in patients with NVAF and who have suffered a recent ischemic stroke in prospective randomized trials. Thus, the aim of the STABLED clinical trial is to investigate the efficacy and safety of CA with anticoagulant therapy using edoxaban in patients with NVAF and a history of recent ischemic stroke. Methods and design: The STABLED trial is a multicenter, prospective, randomized, open-label, standard medication-controlled study in Japan. The target patient number is 250, comprising 125 patients receiving standard medication and 125 receiving CA. For patients allocated to the CA group, ablation is to be performed between 1 to 6 months from the onset of index stroke. The observation period will be 3 years from the day of random allocation of the final patient to any of the groups. The primary outcome measure is the composite of recurrence of ischemic stroke, systemic embolism, all-cause death, and hospitalization for heart failure. Conclusion: This study will investigate the effectiveness and safety of CA and basic anticoagulation treatment with edoxaban for patients with NVAF who have suffered a recent ischemic stroke. The aim is to determine the best evidence for an optimal treatment strategy for patients with NVAF and recent stroke. Trial registration: UMIN000031424/NCT03777631.

DOI： 10.1016/j.jjcc.2019.06.002

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: The newly formed geometry between the native Valsalva and implanted transcatheter heart valve (THV) may induce local thrombogenicity. This study aimed to assess the incidence of and the clinical outcomes associated with Valsalva thrombus formation after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: We retrospectively evaluated the multidetector computed tomography (MDCT) data of 338 patients following transcatheter aortic valve implantation (TAVI) using a balloon-expandable THV. The Valsalva and leaflet thrombi were assessed by MDCT at the left coronary cusp (LCC), right coronary cusp (RCC), and non-coronary cusp (NCC). Combined endpoints such as death, stroke, and readmission for heart failure rates in patients with and without Valsalva and/or leaflet thrombus were examined at two years. The overall incidence of Valsalva and leaflet thrombi was 8.9% and 8.3%, respectively. Significant differences in the location of the Valsalva thrombus in the LCC, RCC, and NCC were noted (5.0%, 4.2%, 8.9%, respectively, p<0.001). The independent predictor for increased risk of Valsalva thrombus was high Valsalva area to implanted THV size ratio (odds ratio 11.8, 95% confidence interval [CI]: 1.67-83.0, p=0.013). Combined endpoints were similar in patients with and without Valsalva thrombus, Valsalva/leaflet thrombus, and leaflet thrombus (p>0.05 for all). CONCLUSIONS: Valsalva thrombus was detected in 8.9% of patients following balloon-expandable THV implantation and was common in the LCC, but it did not increase the risk of adverse events after TAVI.

DOI： 10.4244/EIJ-D-19-00370

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2019 The Author(s) Purpose: Hydrogen (H2) has been reported to scavenge free radicals, particularly the hydroxyl radical (·OH). Ultrasound oscillation in an aqueous solution produces ·OH. Our recent study demonstrated that H2 dissolved in an irrigation solution prevented corneal endothelial damage during phacoemulsification in an animal model. We examined the effects of H2 during clinical phacoemulsification. Design: A single-center, prospective, randomized, double-masked clinical trial. Methods: Thirty-two patients who had cataracts of similar nucleus hardness in both eyes (age: 75.4±7.68 years; 17 males, 15 females) were recruited. Phacoemulsification was performed using a solution of dissolved H2 in one eye, and a conventional solution in the contralateral eye. Endothelial cell density (ECD) at the center of the cornea was measured using noncontact specular microscopy preoperatively and at 1 day, 1 week, and 3 weeks postoperatively. Results: Reduction rates of ECD (mean ± standard deviation) were 16.0%±15.7% at 1 day, 15.4%±16.1% at 1 week, and 18.4%±14.9% at 3 weeks in the control group, compared to 6.5%±8.7% at 1 day (P =.003), 9.3%±11.0% at 1 week (P =.039), and 8.5%±10.5% at 3 weeks (P =.004) in the H2 groups. These rates were significantly smaller in the H2 group at all time points. Conclusions: H2 dissolved in irrigation solution reduced corneal endothelial damage during phacoemulsification. This suggests that a considerable part of the corneal endothelial damage during phacoemulsification is caused by oxidative stress, and that H2 is useful in clinical phacoemulsification.

DOI： 10.1016/j.ajo.2019.04.014

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The relationship between outcome and trigger in takotsubo syndrome (TTS) has been recently discussed, but the data are still limited. Methods and Results: We enrolled 745 consecutive patients with TTS from the Tokyo Cardiovascular Care Unit Network registry. The patients were divided into 4 groups based on trigger: (1) medical illness, 202 (27%); (2) physical activity, trauma and injury, 54 (7%); (3) emotional trigger, 199 (27%); and (4) unidentifiable trigger, 290 (39%). Compared with other groups, the medical illness group had the lowest percentage of female patients (68%, 85%, 89%, and 79%, respectively; P<0.001) and the highest mean patient age (75±11 years, 72±11, 73±12, and 75±11 years, respectively; P=0.02). In-hospital all-cause mortality was higher (11%) in this group (0%, 2%, and 2%, respectively; P<0.001). On multivariate logistic regression analysis, the medical illness group independently predicted all-cause death (OR, 4.73; 95% CI: 1.33-16.87); although there was no significant difference in cardiac deaths between the 4 groups. Conclusions: TTS has a wide spectrum of outcome depending on the trigger. The medical illness trigger was a powerful predictor of outcome but the main cause of death is not cardiac complication.

DOI： 10.1253/circrep.CR-19-0045

PubMed

researchmap

© 2019 World Stroke Organization. Rationale: Bridging therapy with endovascular therapy (EVT) and intravenous thrombolysis (IVT) has been reported to improve outcomes for acute stroke patients with large-vessel occlusion in the anterior circulation. While the IVT may increase the reperfusion rate, the risk of hemorrhagic complications increases. Whether EVT without IVT (direct EVT) is equally effective as bridging therapy in acute stroke remains unclear. Aim: This randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator for acute stroke with ICA and M1 occlusion aims to clarify the efficacy and safety of direct EVT compared with bridging therapy. Methods and design: This is an investigator-initiated, multicenter, prospective, randomized, open-treatment, blinded-endpoint clinical trial. The target patient number is 200, comprising 100 patients receiving direct EVT and 100 receiving bridging therapy. Study outcome: The primary efficacy endpoint is a modified Rankin Scale score of 0–2 at 90 days. Safety outcome measures are any intracranial hemorrhage at 24 h. Discussion: This trial may help determine whether direct EVT should be recommended as a routine clinical strategy for ischemic stroke patients within 4.5 h from onset. Direct EVT would then become the choice of therapy in stroke centers with endovascular facilities. Trial registration: UMIN000021488.

DOI： 10.1177/1747493019840932

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2018 Background: Whether antithrombotic agents should be stopped before prostate biopsy is unsettled. We investigated the impact of antithrombotic agents on bleeding complications after prostate biopsy. Materials and methods: Among the patients who underwent transrectal ultrasound-guided prostate biopsy from June 2006 to December 2013 at Ebina General Hospital, Kanagawa, Japan, 1817 cases were retrospectively assessed. Patients were divided into two groups: those not taking antithrombotic agents (control group) and those taking them (experimental group). The frequency and severity of bleeding complications after the procedure were compared. The severity of bleeding events was graded using the Common Terminology Criteria for Advanced Events vol. 4.0. Results: Hemorrhagic complications were classified into grades 1 to 3. Patients with complications of Grade 2 and above needed treatment. As for the Grade 1 event, there were no differences between two groups. The frequency of more than Grade 2 bleeding events was 1.7% and 3.5% in the control and experimental group, respectively; the odds ratio was 2.18 (P = 0.039). Grade 3 events occurred in seven patients of the control group (0.5%) and four patients of the experimental group (1.2%). Conclusions: The present study showed that continuation of antithrombotic agents increased the frequency of hemorrhagic complications requiring intervention. It suggests that attention should be paid to the patients taking antithrombotic agents before prostate biopsy.

DOI： 10.1016/j.prnil.2018.06.004

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Prediabetes is a precursor of diabetes and increases the risk of cardiovascular disease. Individuals with prediabetes reportedly have higher C-reactive protein levels, which is a risk factor for diabetes, relative to individuals with normal glucose regulation. Inflammation may play a role in the very early-phase deterioration of glucose metabolism, although there is insufficient knowledge regarding this relationship. Thus, we examined the association between serum C-reactive protein level and the development of three prediabetes markers. METHODS: This study included 743 subjects with normal glucose regulation at baseline who completed oral glucose tolerance tests at baseline and after approximately 5 years. Subjects with a history of cardiovascular disease were excluded. RESULTS: During the 5-year follow-up, 55 subjects developed isolated impaired glucose tolerance (IGT; 2h-plasma glucose levels of 7.8-11.0 mmol/L), 24 subjects developed isolated impaired fasting glucose (IFG; fasting plasma glucose levels of 6.1-7.0 mmol/L), 3 subjects developed IFG plus IGT, and 53 subjects developed isolated elevated glycated hemoglobin levels (HbA1c; level of 41-47 mmol/mol). The multivariate analysis revealed that, relative to the lowest quartile, the highest serum C-reactive protein quartile was independently associated with an increased risk of developing isolated elevated HbA1c levels (odds ratio: 2.95, 95% confidence interval: 1.16-7.51, P=0.024) and marginally associated with an increased risk of developing impaired glucose tolerance plus diabetes. However, C-reactive protein levels were not associated with an increased risk of developing IFG. CONCLUSIONS: Elevated serum C-reactive protein levels independently predicted elevated HbA1c levels, but not IFG.

DOI： 10.1055/a-0869-7584

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2019 American Heart Association, Inc. Background: The occurrence and clinical impact of untreated subclinical leaflet thrombosis beyond 1 year after transcatheter aortic valve replacement still remain unclear. Methods and Results: In a multicenter transcatheter aortic valve replacement registry, we analyzed data from 485 patients who underwent 4-dimensional multidetector computed tomography posttranscatheter aortic valve replacement performed to survey hypoattenuated leaflet thickening with reduced leaflet motion compatible with thrombus at a median of 3 days, 6 months, 1 year, 2 years, and 3 years. Incidence, predictors, and clinical outcomes of early (median 3 days) and late (>30 days) leaflet thrombosis were assessed. Additional anticoagulation was not administered because of subclinical findings at the time of computed tomography in all patients. Early leaflet thrombosis occurred in 45 (9.3%) of 485 patients. Mean pressure gradient at discharge was higher in patients with early leaflet thrombosis than in those without. Independent predictors of early leaflet thrombosis in balloon-expandable prostheses were low-flow, low-gradient aortic stenosis, severe prosthesis-patient mismatch, and 29-mm prostheses. No predictors could be identified for self-expanding prosthesis. Cumulative event rates of death, stroke, or rehospitalization for heart failure over 2 years were 10.7% and 16.9% in patients with and without early leaflet thrombosis, respectively (P=0.63). Late leaflet thrombosis occurred late up to 3 years, and male sex and paravalvular leak less than mild were independent predictors. Conclusions: Untreated early leaflet thrombosis did not affect the cumulative event rates of death, stroke, and rehospitalization for heart failure. Late leaflet thrombosis was newly detected during 3-year follow-up.

DOI： 10.1161/CIRCINTERVENTIONS.118.007349

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2018 Diabetes Canada Objectives: Prediabetes is a precursor of diabetes and increases the risk for cardiovascular disease. A high C-reactive protein (CRP) level is a risk factor for diabetes, and individuals with prediabetes have higher CRP levels than those with normal glucose tolerance. In addition, systemic inflammation may play a role in the early-phase deterioration of glucose metabolism. We examined the association between serum CRP levels and prediabetes. Methods: Overall, 4,101 subjects without diabetes underwent oral glucose tolerance tests. Levels of serum CRP were divided into quartiles; the lowest quartile was used as the reference when calculating odds ratios (ORs) and confidence intervals. Isolated fasting glucose, isolated glucose tolerance and elevated glycated hemoglobin levels (i.e. between 42 and 47 mmol/mol [6.0% to 6.4%]) were indicative of prediabetes. Results: In the multiple logistic regression analysis, the ORs (95% confidence intervals) for impaired glucose tolerance, impaired fasting glucose and elevated glycated hemoglobin levels corresponding to the highest quartile of CRP levels were 1.67 (1.31 to 2.14); 1.62 (1.15 to 2.28); and 1.47 (1.14 to 1.90), respectively. In the stratified analysis, the ORs for impaired glucose tolerance were consistently higher in the uppermost quartile than in the reference quartile in both the presence and absence of hypertension or dyslipidemia. In contrast, the ORs for impaired fasting glucose in the uppermost quartile were higher only in the presence of hypertension and dyslipidemia, and the OR for elevated glycated hemoglobin levels in the uppermost quartile was higher only in the presence of hypertension. Conclusions: Elevated serum CRP levels are associated with prediabetes, particularly impaired glucose tolerance.

DOI： 10.1016/j.jcjd.2018.03.007

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Copyright © 2019 Ueda, Nishizaki, Homma, Sanada, Otsuka, Yasuno, Matsuyama, Yanagisawa, Nagao, Fujibayashi, Nojiri, Seo, Yamada, Devos and Daida. Background: The number of papers published by an institution is acknowledged as an easy-to-understand research outcome. However, the quantity as well as the quality of research papers needs to be assessed. Methods: To determine the relation between the number of published papers and paper quality, a survey was conducted to assess publications focusing on interventional clinical trials reported by 11 core clinical research hospitals. A score was calculated for each paper using Système d’interrogation, de gestionet d’analyse des publications scientifiques scoring system, allowing for a clinical paper quality assessment independent of the field. Paper quality was defined as the relative Journal impact factor (IF) total score/number of papers. Results: We surveyed 580 clinical trial papers. For each of the 11 medical institutions (a–k), respectively, the following was found: number of published papers: a:66, b:64, c:61, d:56, e:54, f:51, g:46, h:46, i:46, j:45, k:45 (median: 51, maximum: 66, minimum: 45); total Journal IF: a:204, b:252, c:207, d:225, e:257, f:164, g:216, h:190, i:156, j:179, k:219 (median: 207, maximum: 257, minimum: 156); relative Journal IF total score: a:244, b:272, c:260, d:299, e:268, f:215, g:225, h:208, i:189, j:223, k:218 (median: 225, maximum: 299, minimum: 189); and paper quality (relative Journal IF total score/ number of papers): a:3.70, b:4.25, c:4.26, d:5.34, e:4.96, f:4.22, g:4.89, h:4.52, i:4.11, j:4.96, k:4.84 (median: 4.52, maximum: 5.34, minimum: 3.70). Additionally, no significant relation was found between the number of published papers and paper quality (correlation coefficient, −0.33, P = 0.32). Conclusions: The number of published papers does not correspond to paper quality. When assessing an institution’s ability to perform clinical research, an assessment of paper quality should be included along with the number of published papers.

DOI： 10.3389/fphar.2019.01228

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Treatment with TAS-102 has significantly improved the progression-free survival (PFS) and overall survival (OS) of patients with metastatic colorectal cancer (mCRC). Reportedly, the combination of TAS-102 plus bevacizumab extends the median PFS. The present study aimed to confirm the efficacy and safety of TAS-102 plus bevacizumab (biweekly administration) as third-line chemotherapy for patients with mCRC. METHODS/DESIGN: This is a single-arm, open-label, prospective, nonrandomized, multicenter phase II trial conducted in Japan. With a threshold and expected PFS of 2.1 and 3.5 months, respectively, the simulation results showed a sample size of 42 with α = 0.05 (both sides) for 90% power, based on the One-Arm Binomial test using the SWOG statistical tool. If the estimated dropout is 7%-8%, the target sample size is estimated to be 45. The TAS-CC4 study regimen comprised 28-day cycles with biweekly oral administration of TAS-102 (35 mg/m2 twice daily on days 1-5 and 15-19 of every 28-day cycle) and bevacizumab (5.0 mg/kg on days 1 and 15). The primary end point is the PFS; secondary end points include response rate (RR), OS, grade ≥3 neutropenia, and genetic alterations (KRAS/BRAF mutations) in the circulating cell-free DNA. DISCUSSION: The present study can contribute to the determination of the effective dosing interval of TAS-102 and bevacizumab in patients with mCRC and is thought to lead to prophylaxis of neutropenia and prolongation of the treatment period.

DOI： 10.23922/jarc.2018-043

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2018, Springer Japan KK, part of Springer Nature. The prognostic impact of a decreased blood glucose level in acute heart failure (AHF) has not been sufficiently clarified. The data from 1234 AHF patients were examined in the present study. The blood glucose (BG) levels were evaluated at admission. The patients were divided into groups based on the following: with or without diabetes mellitus (DM), and BG level ≥ 200 mg/dl (elevated BG) or < 200 mg/dl (decreased BG). The elevated and decreased BG patients were further divided into another three groups: 200 mg/ml ≤ BG < 300 mg/dl (mild-elevated), 300 mg/ml ≤ BG < 400 mg/dl (moderate-elevated) and BG ≥ 400 mg/ml (severe-elevated); and 150 mg/ml ≤ BG < 200 mg/dl (mild-decreased), 100 mg/ml ≤ BG < 150 mg/dl (moderate-decreased) and BG < 100 mg/ml (severe-decreased), respectively. The DM patients had a significantly poorer mortality than the non-DM patients. The prognosis was different between patients with elevated or decreased BG. In DM patients with elevated BG, the severe-elevated patients had a significantly poorer prognosis than moderate- and mild-elevated patients. In the DM patients with decreased BG, the severe-decreased patients had a significantly poorer prognosis than those moderate- and mild-decreased patients. The multivariate Cox regression model showed that a severe-decreased [hazard ratio (HR) 3.245, 95% confidence interval (CI) 1.271–8.282] and severe-elevated (HR 2.300, 95% CI 1.143–4.628) status were independent predictors of 365-day mortality in AHF patients with DM. The mortality was high among AHF patients with DM. Furthermore, both severe hyperglycemia and hypoglycemia were independent predictors of the mortality in patients with AHF complicated with DM.

DOI： 10.1007/s00380-018-1151-3

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2018 The Authors. Background Although transcatheter aortic valve replacement (TAVR) is the least invasive treatment for patients with symptomatic aortic stenosis, some patients hesitate to undergo the procedure. We investigated the clinical impact of treatment delay after patient refusal of TAVR. Methods and Results We used the Japanese OCEAN (Optimized Catheter valvular intervention) regsitry data of 1542 patients who underwent TAVR. Refusal was defined as at least 1 refusal of TAVR at the time of informed consent. Patients were separated into 2 groups: refusal (28/1542, 1.8%) and non-refusal (1514/1542, 98.2%). We compared the baseline characteristics, procedural outcomes, and mortality rates between the groups. Additionally, data on reasons for refusal and those leading to eventually undergoing TAVR were collected. Age, surgical risk scores, and frailty were higher in the refusal group than in the non-refusal group (P<0.05 for all). Periprocedural complications did not differ between groups, whereas 30-day and cumulative 1-year mortality were significantly higher in the refusal group than in the non-refusal group (7.1% versus 1.3%, P=0.008 and 28.8% versus 10.3%, P=0.010, respectively). Multivariate Cox regression analysis revealed that TAVR refusal was an independent predictor of increased midterm mortality (hazard ratio: 3.37; 95% confidence interval: 1.52-7.48; P=0.003). The most common reason for refusal was fear (13/28, 46.4%), and the most common reason for changing their mind was worsening heart failure (21/28, 75.0%). All patients in the refusal group decided to undergo TAVR within 20 months (median: 5.5 months). Conclusions Refusing TAVR even once led to poorer prognosis; therefore, this fact should be clearly discussed when obtaining informed consent.

DOI： 10.1161/JAHA.118.009195

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2018 The Author(s) The purpose of this study was to determine the 22-year experience of the relationship between preoperative left atrial diameter (LAD) and atrial fibrillation (AF) recurrence after AF surgery. Between November 1993 and April 2015, 244 patients underwent AF surgery concomitant with mitral valve surgery, and were completely followed up in our institute. The full-maze procedure was performed in 231 patients and pulmonary vein isolation in 13. Three quartiles divided the list of sorted LAD data into 4 groups: group Q1: LAD = 40.5 ± 4.3 (n = 55), group Q2: LAD = 47.9 ± 2.0 (n = 61), group Q3: LAD = 54.2 ± 1.6 (n = 66), and group Q4: LAD = 64.2 ± 5.6 (n = 62). The AF cure rates for 22 years were verified between the groups. Although the AF cure rate of the full-maze procedure was 94%, 80%, 63%, and 51% at 1, 5, 10, and 20 years after AF surgery, respectively, it was 100% at 5 and 10 years after the pulmonary vein isolation (P = 0.088). Although there were no significant differences in the AF cure rate between groups Q1-Q3, the AF cure rate was significantly lower in group Q4 than the other groups (P < 0.001). A multivariate Cox proportional hazard model revealed that the preoperative LAD and cardiothoracic ratio were significant risk factors of AF recurrence (hazard ratio 1.063 per 1-mm increase, P = 0.003, and hazard ratio 1.064 per 1% increase, P = 0.043, respectively). AF surgery was effective for 22 years after surgery for AF concomitant with mitral valve disease. A preoperative LAD of ≥58.0 mm and the cardiothoracic ratio were risk factors of AF recurrence after AF surgery.

DOI： 10.1053/j.semtcvs.2018.01.004

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2018 Background: Nutritional condition is one marker of patients’ frailty. The Geriatric Nutritional Risk Index (GNRI) is a well-known marker of nutritional status. This study sought to assess the clinical outcomes of GNRI after transcatheter aortic valve replacement (TAVR). Methods: We evaluated the GNRI value of 1,613 patients who underwent TAVR using data from a Japanese multicenter registry. According to baseline GNRI, patients were classified into 3 groups: GNRI ≥92 (n = 1,085; 67.3%), GNRI 82-92 (n = 396; 24.6%), and GNRI ≤82 (n = 132; 8.2%). Baseline characteristics, procedural outcomes, and cumulative mortality rates were compared. In addition, GNRI correlations with other frailty components (gait speed, grip strength, and Clinical Frailty Scale) and Society of Thoracic Surgeons (STS) score were also evaluated. Results: Significantly increased mortality rates were observed across the 3 groups at 30 days (0.9%, 2.3%, and 6.8%, respectively; P <.001) and 1 year (6.5%, 16.4%, and 36.4%, respectively; P <.001). Both GNRI 82-92 and GNRI ≤82 (as a reference for GNRI ≥92) were independently associated with increased midterm mortality in the Cox regression multivariate model (hazard ratio: 1.97, 3.60; 95% confidence interval: 1.37-2.84, 2.30-5.64; P <.001, P <.001, respectively). The GNRI value was significantly correlated with gait speed (Spearman ρ = −0.15, P <.001), grip strength (ρ = 0.25, P <.001), Clinical Frailty Scale (ρ = −0.24, P <.001), and STS score (ρ = −0.29, P <.001). Conclusions: GNRI is related to both frailty components and the STS score and is an important surrogate marker for predicting worse clinical outcomes after TAVR. Assessment of the GNRI may be considered when deciding on TAVR.

DOI： 10.1016/j.ahj.2018.04.021

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2017 Elsevier B.V. Objective: Clarification of the association between the swallowing function and respiratory and phonatory functions. Methods: The subjects were 30 patients with a chief complaint of swallowing disorder with clear consciousness capable of retaining a sitting position. Patients with organic and functional diseases of the larynx were excluded. Twenty-two and eight patients were male and female, respectively, and the mean age was 77.0 ± 14.6 years old. The chest expansion score was measured as an index of the respiratory function, and the maximum phonation time (MPT) was measured as an index of the phonatory function. The presence or absence of aspiration was judged using videoendoscopic swallowing study (VESS) and videofluoroscopic swallow studies (VFSS). The patients were divided into those with and without aspiration, and the chest expansion score and MPT were compared. In addition, the distance of laryngeal elevation was measured in the lateral view of VFSS, and its correlations with the chest expansion score and MPT were closely analyzed. To evaluate reliability of the test, the distance of laryngeal elevation and videoendoscopic score were compared between the presence and absence of aspiration. Results: The distance of laryngeal elevation was significantly shortened and the videoendoscopic score was significantly higher in the group with aspiration, as previously reported. On comparison of the chest expansion score between the groups with and without aspiration, no significant difference was noted at the axillary or xiphoid process level, and shortening was significant only at the 10th rib level in the group with aspiration. On comparison of MPT, it was significantly shortened in the group with aspiration. In addition, a significant positive correlation with the distance of laryngeal elevation was noted in both chest expansion score and MPT. Conclusion: It was suggested that declines of the respiratory and phonatory functions are risk factors of aspiration through limiting laryngeal elevation, and the chest expansion score at the 10th rib level and MPT are useful for screening of aspiration.

DOI： 10.1016/j.anl.2017.08.009

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© Annals of Cardiothoracic Surgery. There are no standardized criteria for measuring patients' frailty. We examined prognosis based on four frailty markers [serum albumin level, grip strength, gait speed, and clinical frailty scale (CFS)] in patients who underwent transcatheter aortic valve replacement (TAVR) between October 2013 and April 2016 and were recorded in the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry. Serum albumin level was assessed by dividing patients into two groups: hypoalbuminemia or non-hypoalbuminemia according to their serum albumin level. Clinical outcomes including all-cause, cardiovascular and non-cardiovascular mortality rates after TAVR were compared. During the follow-up period cumulative all-cause, cardiovascular and non-cardiovascular mortality rates were significantly higher in the hypoalbuminemia group than in the non-hypoalbuminemia group. This result remained unchanged even after a propensity-matched model was used in terms of cumulative all-cause and non-cardiovascular mortality; however, differences in cardiovascular mortality rates were attenuated. To consider the impact of grip strength patients were divided into a low or high peak grip strength group based on classification and regression tree (CART) survival analysis. The clinical outcomes for each sex were compared between the two groups. In both sexes the cumulative 1-year mortality rates were significantly different between the two groups. To investigate gait speed patients were classified into two gait speed groups (low or high gait speed group) based on CART survival analysis. Clinical outcomes were compared between the two groups. The cumulative 1-year mortality rate was significantly different between the two gait speed groups. The effect of CFS on prognosis after TAVR was assessed. Patients were categorized into five groups based on the following CFS scores: CFS1-3, CFS4, CFS5, CFS6, and CFS =7. We evaluated the relationship between the CFS score and other indicators of frailty markers. We also assessed the mid-term mortality among the five groups. The CFS score had a significant correlation with other frailty markers. The cumulative 1-year mortality increased with an increasing CFS score. In the Cox regression multivariable analysis, the CFS score was an independent predictive factor of an increased late cumulative mortality risk. In conclusion, the results suggest that serum albumin level, grip strength, gait speed, and CFS score are all useful indicators when considering the optimal indications and risk stratification for TAVR.

DOI： 10.21037/acs.2017.09.06

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

© 2017 American Heart Association, Inc. Background: Gait speed reflects an important factor of frailty and is associated with an increased risk of late mortality in patients with cardiac disease. This study sought to assess the prognostic value of gait speed in elderly patients who underwent transcatheter aortic valve replacement. Methods and Results: We investigated the 5-m or 15-feet gait speed (m/sec) in 1256 patients who underwent transcatheter aortic valve implantation using data from the OCEAN-TAVI Japanese multicenter registry (Optimized Catheter Valvular Intervention-Transcatheter Aortic Valve Implantation). Baseline characteristics, procedural outcomes, and all-cause mortality were compared among groups defined by differential gait speed classification: model 1, normal (>0.83 m/sec; n=563; 44.8%), slow (0.5-0.83 m/sec; n=429; 34.2%), slowest (<0.83 m/sec; n=205; 16.3%), unable to walk (n=48; 3.8%); and model 2, classification and regression tree survival model indicating the threshold of gait speed as 0.385 m/sec (>0.385 m/sec; n=1080 versus ≤0.385 m/sec; n=117). The cumulative 1-year mortality rate showed significant differences in the classical gait speed groups in model 1 (7.6%, 6.6%, 18.2%, and 40.7%, respectively; P<0.001) and survival classification and regression tree group in model 2 (7.7% versus 21.9%; P<0.001). The slowest walkers and those unable to walk demonstrated independent associations with increased midterm mortality after adjustment for several confounding factors (hazard ratio, 1.83, 4.28; 95% confidence interval, 1.03-3.26, 2.22-8.72; P=0.039, <0.001, respectively). Gait speed <0.385 m/sec determined by classification and regression tree also independently associated with worse prognosis (hazard ratio, 2.40; 95% confidence interval, 1.75-5.88; P=0.001). Conclusions: Gait speed using both traditional and specific classification is useful as a potential marker for predicting vulnerable patients associated with adverse clinical outcomes after transcatheter aortic valve replacement.

DOI： 10.1161/CIRCINTERVENTIONS.117.005088

Scopus

PubMed

researchmap

記述言語：英語   出版者・発行元：ELSEVIER SCIENCE BV  

DOI： 10.1016/j.jjcc.2017.02.001

Web of Science

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. OBJECTIVES: To identify factors that determine early saphenous vein graft failure (VGF) within 1 month after coronary artery bypass grafting (CABG). METHODS: Seven hundred forty-nine consecutive patients underwent primary isolated CABG with saphenous vein grafts at three Japanese centres from 1 January 2005 to 31 December 2014. According to angiographic findings within 1 month of CABG surgery, 63 patients (8.4%) developed early VGF. We examined the relationships between variables and early VGF by using multivariable logistic regression analysis. RESULTS: The preoperative clinical characteristics were similar between patients with and without early VGF, except for median preoperative haemoglobin A1c levels, which were significantly higher among patients with early VGF (6.7 vs 6.4%, P = 0.046). Additionally, anastomosis to the vessel with chronic total obstruction was performed more frequently among patients with early VGF (22/63 [34.9%] vs 140/686 [20.4%], P = 0.007), and myocardial infarction during the hospital admission occurred more frequently among patients with early VGF (4/63 [6.3%] vs 2/686 [0.3%], P < 0.0001). Results of multivariable analysis showed that the preoperative haemoglobin A1c level was associated with early VGF (odds ratio per unit increase, 1.30; 95% confidence interval, 1.06-1.60; P = 0.013). CONCLUSIONS: An increased preoperative haemoglobin A1c level was strongly associated with early VGF after CABG. Thus, VGF happened more frequently in patients with poorly controlled diabetes mellitus.

DOI： 10.1093/icvts/ivw343

Scopus

PubMed

researchmap

担当区分：責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

© 2015, Springer Japan. This study aimed to examine the association between the non-invasive measurement of the brachial artery volume elastic modulus (VE), an index of arterial stiffness, and the presence of coronary artery stenosis in patients with suspected stable coronary artery disease (CAD). A total of 135 patients with suspected stable CAD (87 men, mean age, 64 ± 12 years) underwent oscillometric measurement of the brachial artery to obtain VE. Coronary angiography was thereafter carried out to diagnose CAD, defined as having ≥75 % stenosis in the epicardial coronary arteries. VE was significantly higher in patients with CAD (1.94 ± 0.34 mmHg/%) than in those without CAD (1.71 ± 0.35 mmHg/%, P < 0.001). In multiple logistic regression analysis, VE was an independent predictor for the presence of CAD (odds ratio 1.19 per 0.1 mmHg/% increase, 95 % CI 1.04–1.51) even after adjusting for multiple potential confounders including the Framingham risk score (FRS). The area under the curve of the receiver operating characteristic curve analysis for discriminating CAD increased significantly after the addition of VE to the FRS (from 0.75 to 0.81, P = 0.034). The category-free net reclassification improvement and the integrated discrimination improvement by adding VE to the FRS were 0.476 (95 % CI 0.146–0.806) and 0.086 (95 % CI 0.041–0.132), respectively. In conclusion, the brachial VE was significantly associated with the presence of coronary artery stenosis. The additional measurement of VE to the FRS improved the ability to identify patients with coronary artery stenosis among those with suspected stable CAD.

DOI： 10.1007/s00380-015-0769-7

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. Background: To clarify the influence of hypertension and blood pressure (BP) control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J-RHYTHM Registry was performed. Methods and Results: A consecutive series of outpatients with atrial fibrillation was enrolled from 158 institutions. Of 7937 patients, 7406 with nonvalvular atrial fibrillation (70.8% men, 69.8±10.0 years) were followed for 2 years or until an event occurred. Hypertension was defined as a systolic BP ≥140 mm Hg, a diastolic BP ≥90 mm Hg, a history of hypertension, and/or antihypertensive drug use. Hypertension was an independent risk factor for major hemorrhage (hazard ratio 1.52, 95% CI 1.05-2.21, P=0.027) but not for thromboembolism (hazard ratio 1.05, 95% CI 0.73-1.52, P=0.787). When patients were divided into quartiles according to their systolic BP at the time closest to the event or at the end of follow-up (Q1, <114; Q2, 114-125; Q3, 126-135; and Q4, ≥136 mm Hg), odds ratios for both events were significantly higher in Q4 than in Q1 (thromboembolism, odds ratio 2.88, 95% CI 1.75-4.74, P<0.001; major hemorrhage, odds ratio 1.61, 95% CI 1.02-2.53, P=0.041) after adjustment for components of CHA2DS2-VASc score, warfarin use, and antiplatelet use. A systolic BP of ≥136 mm Hg was an independent risk factor for thromboembolism and major hemorrhage. Conclusions: BP control appears to be more important than a history of hypertension and baseline BP values at preventing thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation. Clinical Trial Registration: URL: http://www.umin.ac.jp/ctr. Unique identifier: UMIN000001569.

DOI： 10.1161/JAHA.116.004075

Web of Science

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2015 Diabetes India. Aims It is important to identify the risk factors for metabolic syndrome (MetS) in order to prevent the development of cardio-/cerebrovascular diseases. The authors estimated the risk factors for the development of MetS with special emphasis on the severity of sleep-disordered breathing (SDB). Methods We conducted as a cross-sectional study in subjects undergoing intensive health examination (581 men aged 33-84 years). Diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Expert Panel. Results The prevalence of MetS in subjects with severe SDB, which was defined as an apnea-hypopnea index (AHI) of 30 or higher, was 40.7%, which was significantly higher than that in the subjects without severe SDB (29.3%). The odds ratio (OR) (95% confidence interval [CI]) of the logarithmic-transformed AHI for MetS was 1.6 (1.1-2.4) after adjustments for age, serum uric acid, logarithmic-transformed serum C-reactive protein, smoking history, exercise history and alcohol history. When the subjects were categorized by the severity of SDB, the OR (95% CI) of severe SDB, which was the only category that showed significant association, was 2.2 (1.2-4.0). Conclusion A significant association was observed between severe SDB and the presence of MetS in the subjects (all male) of this study.

DOI： 10.1016/j.dsx.2015.10.005

Scopus

PubMed

researchmap

担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ATHEROSCLEROSIS SOC  

© 2016, Journal of Atherosclerosis and Thrombosis. All rights reserved. Aim: The Japan Atherosclerosis Society Guidelines for the Diagnosis and Prevention of Atherosclerotic Cardiovascular Diseases 2012 (JAS Guidelines 2012) indicate that the management target for serum non-high-density lipoprotein cholesterol (non-HDLC) level is 30 mg/dL higher than that for low-density lipoprotein cholesterol (LDLC) level. However, it remains unclear whether this value is applicable to subjects at a low risk of cardiovascular disease. This study aimed to propose the optimal management target for serum non-HDLC level in low-risk Japanese subjects. Methods: Among 20,909 subjects who underwent annual medical checkup at a Japanese company in 2008, we analyzed the data of 17,023 subjects (14,352 men, mean age 37.8±8.6 years) in risk category I according to the JAS Guidelines 2012. The correlation between LDLC and non-HDLC levels was examined. Results: A strong correlation was found between LDLC and non-HDLC levels (r= 0.95, p<0.001). The following regression equation for calculation of non-HDLC was obtained from linear regression analysis: non-HDLC (mg/dL)=1.09×LDLC (mg/dL)+7.79. According to this equation, the optimal management target for non-HDLC level corresponding to that for LDLC level (160 mg/dL) was 180 mg/dL. A multiple logistic regression analysis revealed that age, obesity, habitual alcohol intake, and current smoking were significantly associated with non-HDLC ≥180 mg/dL. Conclusions: The management target for non-HDLC level is recommended to be set at 20 mg/dL higher than that for the LDLC level (i.e., 180 mg/dL) in low-risk Japanese subjects.

DOI： 10.5551/jat.33068

Web of Science

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2016 Qing Li et al. In the present study, we investigated the effects of a forest bathing on cardiovascular and metabolic parameters. Nineteen middle-aged male subjects were selected after they provided informed consent. These subjects took day trips to a forest park in Agematsu, Nagano Prefecture, and to an urban area of Nagano Prefecture as control in August 2015. On both trips, they walked 2.6 km for 80 min each in the morning and afternoon on Saturdays. Blood and urine were sampled before and after each trip. Cardiovascular and metabolic parameters were measured. Blood pressure and pulse rate were measured during the trips. The Japanese version of the profile of mood states (POMS) test was conducted before, during, and after the trips. Ambient temperature and humidity were monitored during the trips. The forest bathing program significantly reduced pulse rate and significantly increased the score for vigor and decreased the scores for depression, fatigue, anxiety, and confusion. Urinary adrenaline after forest bathing showed a tendency toward decrease. Urinary dopamine after forest bathing was significantly lower than that after urban area walking, suggesting the relaxing effect of the forest bathing. Serum adiponectin after the forest bathing was significantly greater than that after urban area walking.

DOI： 10.1155/2016/2587381

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

© 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Background Human cytomegalovirus (CMV) is a major cause of congenital infection. The seroprevalence of maternal CMV IgG antibodies among Japanese women is decreasing. In this study, we assessed the rate of and risk factors for CMV infection. This article includes a description of a method for the prevention of CMV infection. Methods Medical records of 7,074 women who delivered a baby at our hospital were retrospectively reviewed. For seronegative patients, preventive educational materials were provided, and CMV IgG antibody levels were reassessed during late pregnancy. Congenital infection in neonates from seroconverted mothers was determined by urine analysis. Results The overall CMV IgG seropositivity rate was 69.1%. The prevalence of CMV IgG increased with age and parity. In a multivariate logistic regression analysis, parity remained an independent determinant of CMV IgG seropositivity. The seroconversion rate for CMV IgG antibody during pregnancy was 0.37%. Neonatal congenital CMV infection occurred in 37.5% of seroconverted women. The risk of primary CMV infection in mothers during their first pregnancy was 7.0%, with an average follow-up period of 2.1 years. Conclusion We found that parity was an independent determinant of CMV IgG seropositivity, suggesting that child-rearing may be a high risk factor for maternal CMV infection. The provision of information on hygiene may be an effective and inexpensive method for preventing CMV infection.

DOI： 10.1016/j.ajic.2015.06.026

Scopus

PubMed

researchmap

DOI： 10.1038/hr.2015.59

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved. Objective The association between metabolic syndrome (MetS) and biological inflammatory or anti-coagulant markers were clarified in combination with lifestyle factors. Patients and methods The target subjects were 5102 working men without metabolic diseases, aged 30-60 years old. The authors measured the serum levels of high-sensitivity C-reactive protein (CRP), uric acid and plasma fibrinogen as potential key biomarkers of MetS. Results Mean values of uric acid, log-transformed serum CRP and plasma fibrinogen increased significantly as the number of components of MetS increased after adjustment for age. Multivariate analysis revealed significant associations between the presence of MetS and age, habitual exercise, not current smoking, the log-transformed value of serum CRP and serum uric acid, with odds ratios (ORs) of 1.03 (95% confidence interval (CI): 1.02-1.04; p < 0.001), 0.77 (95% CI: 0.65-0.90; p < 0.01), 0.82 (95% CI: 0.70-0.96; p < 0.05), 3.2 (95% CI: 2.6-3.9; p < 0.001) and 1.5 (95% CI: 1.4-1.6; p < 0.001), respectively for the presence of MetS. Conclusion Elevated serum level of CRP, uric acid, not habitual exercise and current smoking were associated with MetS in this cross-sectional study.

DOI： 10.1016/j.dsx.2015.02.009

Scopus

PubMed

researchmap

DOI： 10.1038/hr.2014.145

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

© 2015 Yuko Kachi et al. Background: Socioeconomic status (SES) as a determinant of obesity has received scant attention in Japan. This study examined the association between SES and overweight among Japanese children and adolescents. Methods: Cross-sectional analyses of a representative sample of Japanese children (6-11 years: n = 397) and adolescents (12-18 years: n = 397) were performed, with measured heights and weights from the 2010 National Health and Nutrition Examination Survey and the 2010 Comprehensive Survey of Living Conditions. Overweight, including obesity, was defined by International Obesity Task Force cut-offs. SES indicators included household income, equivalent household expenditure, parental educational attainment, and parental occupational class. Results: Overweight prevalence was 12.3% in children and 9.1% in adolescents. Adolescents living in middle-income households were more likely to be overweight than those living in high-income households (OR 2.26, 95% CI, 1.01-5.67) after adjustment for age, sex, and parental weight status. Similarly, adolescents living in households with low expenditure levels were more likely to be overweight than those living in households with high expenditure levels (OR 3.40, 95% CI, 1.20-9.60). In contrast, no significant association was observed among children. Conclusions: Our results indicated that low household economic status was associated with being overweight, independent of parental weight status, among Japanese adolescents.

DOI： 10.2188/jea.JE20140108

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

© 2014. Background: We aimed to examine whether serum levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, and C-reactive protein (CRP) are associated with the risk of developing metabolic syndrome in middle-aged men. Methods: In this longitudinal study, serum ADMA and CRP levels were measured in Japanese men without metabolic syndrome, which was diagnosed according to the currently accepted unified criteria. The subjects were followed-up for a maximum of four years to determine new-onset metabolic syndrome. A Cox proportional hazards model with adjusting for potential confounders was applied to determine the hazard ratio (HR) for developing metabolic syndrome according to serum levels of ADMA and CRP, considered either alone or in combination. Results: Of the 848 subjects (mean age, 43. ±. 6. years), 100 subjects developed metabolic syndrome. High ADMA levels (≥. 0.45. μmol/L) alone did not show a significant HR for developing metabolic syndrome, while high CRP levels (≥. 0.3. mg/L) did (HR 1.75, 95% CI 1.12-2.74). The combination of high levels of both CRP and ADMA had a high HR (2.09, 95% CI 1.12-3.76) as compared to low levels of both markers. In contrast, the HR was not significant in the combination of high CRP and low ADMA levels, as well as low CRP and high ADMA levels. Conclusions: Serum CRP, but not ADMA, levels were associated with the risk of metabolic syndrome. Nevertheless, the risk of metabolic syndrome could be predicted more reliably by considering these two markers together rather than CRP alone.

DOI： 10.1016/j.ijcme.2014.10.001

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

© 2014 American Heart Association, Inc. Background-Transcatheter aortic valve implantation (TAVI) performed under local anesthesia (LA) is becoming increasingly common. We aimed to compare the clinical outcomes in patients who underwent transfemoral-TAVI under general anesthesia (GA) and LA. Methods and Results-Data from 2326 patients in the French Aortic National CoreValve and Edwards 2 (FRANCE 2) registry who underwent transfemoral-TAVI were analyzed. During the study period, the percentage of LA procedures increased gradually from 14% in January 2010 to 59% in October 2011. The clinical outcomes for GA (n=1377) and LA (n=949) were compared. Numerous baseline characteristics differed between the 2 groups, and the use of transesophageal echocardiographic guidance was more common in GA than in LA (76.3% versus 16.9%; P<0.001). Device success and cumulative 30-day survival rates were similar in the 2 groups (97.6% versus 97.0%; P=0.41 and 91.6% versus 91.3%; P=0.69, respectively), whereas the incidence of postprocedural aortic regurgitation≥mild was significantly lower in GA than in LA (15.0% versus 19.1%; P=0.015). The groups were also analyzed using a propensity-matching model, including transesophageal echocardiographic usage (GA [n=401] versus LA [n=401]). This model indicated that there were no significant differences between the 2 groups in the rates of 30-day survival (GA [91.4%] versus LA [89.3%]; P=0.27] and postprocedural aortic regurgitation≥mild (GA [12.7%] versus LA [16.2%]; P=0.19). Conclusions-The less invasive transfemoral-TAVI under LA is preferred in clinical settings and seems to be acceptable; however, the higher incidence of postprocedural aortic regurgitation is emphasized. Therapeutic efforts should be made to reduce such complications during transfemoral-TAVI under LA.

DOI： 10.1161/CIRCINTERVENTIONS.113.000403

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS  

BACKGROUND: The aim of this study was to examine the predictive value of serum cystatin C (CysC) and that of creatinine-based estimated glomerular filtration rate (eGFRCreat) for the risk of incident hypertension in a middle-aged male population. METHODS: Serum CysC levels were measured in 904 nonhypertensive, Japanese male subjects (mean age = 44±6 years) who received an annual general health examination in a company. Serum creatinine levels were simultaneously measured, and eGFRCreat was calculated. Subjects were followed-up for a maximum period of 4 years, and annual blood pressure measurements were recorded. RESULTS: During the follow-up period, 124 subjects developed hypertension, defined as systolic/diastolic blood pressure ≥140/90 mmHg or use of antihypertensive medications. In the Kaplan-Meier analysis, both the third quintile of CysC and that of eGFRCreat showed the lowest 4-year cumulative incident rate of hypertension. The multiadjusted hazard ratio for incident hypertension was significantly increased in the highest quintile of CysC compared with the third quintile (2.60; 95% confidence interval (CI) = 1.41-4.77; P = 0.002), as well as compared with the lowest 4 quintiles combined (1.89; 95% CI = 1.26-2.84; P = 0.002). However, eGFRCreat did not show significant hazard ratios for incident hypertension in any of the adjusted models. CONCLUSIONS: Elevated serum CysC levels could predict the risk of incident hypertension in this study population with a maximum follow-up period of 4 years. In contrast, eGFRCreat did not show predictive value for the risk of incident hypertension. © 2013 American Journal of Hypertension, Ltd. All rights reserved.

DOI： 10.1093/ajh/hpt164

Web of Science

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Background Asymmetric dimethylarginine (ADMA) has recently been investigated as a risk marker for cardio- and cerebrovascular diseases. However, whether ADMA levels are related to the risk of stroke in the Japanese general population remains unclear. Methods We examined 769 Japanese men (mean age, 47 ± 5 years) undergoing health examinations. Each subject's ADMA level and various vascular risk factors were assessed; the predicted 10-year stroke risk was calculated using the point-based prediction model from the Japan Public Health Center Study. Results In a multiple linear regression analysis, age, body mass index, estimated glomerular filtration rate, and current smoking status were significant independent determinants of ADMA levels. A significant odds ratio (OR) for high predicted stroke risk (10-year risk ≥ 5%)was noted in the highest quartile of ADMA levels (OR, 2.47; 95% CI, 1.002-6.07), compared with the lowest quartile, after adjusting for potential confounding factors. A significant OR for high predicted stroke risk was also found for each standard deviation increment in ADMA level (adjusted OR, 1.46; 95% CI, 1.10-1.92). Conclusion Elevated ADMA levels were significantly associated with an increased predicted stroke risk, suggesting that measuring ADMA levels may be useful for identifying middle-aged Japanese men with a high risk of stroke. © 2013 Elsevier B.V.

DOI： 10.1016/j.jns.2013.12.021

Scopus

PubMed

researchmap

担当区分：最終著者   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ijcard.2013.11.107

Scopus

PubMed

researchmap

担当区分：責任著者   掲載種別：研究論文（学術雑誌）  

Aims: Elevated post-load plasma glucose levels may increase the risk of cardiovascular disease, even when they are within the normoglycaemic range. We examined the association of carotid artery intima-media thickness, a marker of early atherosclerosis, with glycaemic variables, including post-load plasma glucose levels, in Japanese subjects with normal glucose tolerance. Methods: The study participants were 663 Japanese subjects with normal glucose tolerance (565 men, mean age 47 ± 9 years) who underwent both a 75-g oral glucose tolerance test and carotid artery intima-media thickness measurement by B-mode ultrasonography during a health examination. Associations between maximal common carotid artery intima-media thickness and fasting plasma glucose, 1-h and 2-h plasma glucose during an oral glucose tolerance test, and HbA1c were examined. Results: The carotid artery intima-media thickness gradually increased across the tertiles of 1-h plasma glucose, 2-h plasma glucose and HbA1c. In multiple linear regression analysis, 2-h plasma glucose (β = 0.09, P = 0.012), as well as age, male gender, hypertension, dyslipidaemia, and current smoking were independent determinants of carotid artery intima-media thickness. In contrast, other glycaemic variables were not independent determinants of carotid artery intima-media thickness. The carotid artery intima-media thickness in hypertensive subjects with the highest tertile of 2-h plasma glucose [0.70 (95% CI 0.64-0.76) mm] was significantly greater than in normotensive subjects, with the lowest tertile of 2-h plasma glucose [0.60 (95% CI 0.58-0.63) mm, P = 0.037], even after adjusting for the multiple potential confounders. Conclusions: The 2-h plasma glucose during an oral glucose tolerance test was positively and independently associated with carotid artery intima-media thickness in Japanese subjects with normal glucose tolerance. In particular, the combination of elevated 2-h plasma glucose and hypertension may contribute to an increased carotid artery intima-media thickness. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

DOI： 10.1111/dme.12288

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

BACKGROUND: The relationship between job stress and job satisfaction by the follow-up study should be more evaluated for workers' health support.OBJECTIVE: Job stress is strongly affected by the content of the job and the personality of a worker. This study was focused on determining the changes of the job stress and job satisfaction levels over a two-year interval, using the Brief Job Stress Questionnaire (BJSQ).METHODS: This self-administered questionnaire was distributed to the same 310 employees of a Japanese industrial company in 2009 and 2011. Sixty-one employees were lost from 371 responders in 2009. Data of 16 items from 57 items graded on a four-point Likert-type scale to measure the job stressors, psycho-physical complaints and support for workers, job overload (six items), job control (three items), support (six items) and job satisfaction score (one item) were selected for the analysis.RESULTS: The age-adjusted partial correlation coefficients for job overload, job control and support were 0.684 (p< 0.001), 0.474 (p< 0.001) and 0.612 (p< 0.001), respectively. The concordance correlation coefficient (and 95% confidence interval indicated within parentheses) for job overload, job control and support were 0.681 (0.616-0.736), 0.473 (0.382-0.555), and 0.623 (0.549-0.687), respectively. There were no significant differences in the mean score for job overload, job control or support, although significant decline in the job satisfaction level was apparent at the end of the two-year period (p< 0.05). There was also a significant decline in the job satisfaction in 2009 and in 2011 for subjects with keeping low job strain.CONCLUSIONS: No significant changes in the scores on the three elements of job stress were observed over the two-year study period, and the job satisfaction level deteriorated significantly during this period. There was a decline in the job satisfaction in the two-year period, although subjects did not suffer from job stress at the same period.

DOI： 10.3233/WOR-131658

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Aim: Asymmetric dimethylarginine (ADMA) has recently been investigated as a risk marker for cardio-and cerebrovascular diseases. However, it is not currently known whether the ADMA levels are related to the risk of stroke in Japanese women. Methods: We examined 192 Japanese women (mean age, 55±9 years, range, 40-80 years) who underwent health examinations. The ADMA level and various vascular risk factors of each subject were assessed, and the predicted 10-year stroke risk was calculated using the point-based prediction model provided by the Japan Public Health Center study. Results: In a correlation coefficient analysis, age was found to be the only factor significantly correlated with the ADMA level. A significant odds ratio (OR) for a high predicted stroke risk (10-year risk, ≥5%) was noted in the highest ADMA level tertile (6.24; 95% CI, 1.13-34.5; p=0.036) compared with the lowest tertile, after adjusting for potential confounding factors. A significant OR for a high predicted stroke risk was also found for each increment in the ADMA tertile and standard deviation (adjusted OR, 2.42; 95% CI, 1.09-5.34; p=0.029; and 2.51; 95% CI, 1.24-5.11; p=0.011, respectively). Conclusions: An elevated ADMA level is significantly associated with an increased predicted stroke risk, suggesting that measuring the ADMA level is useful for identifying Japanese women with an elevated stroke risk.

DOI： 10.5551/jat.22582

Scopus

PubMed

researchmap

担当区分：最終著者   掲載種別：研究論文（学術雑誌）  

A 3-year follow-up study of an occupational cohort was conducted to clarify the effect of the type of shift work on the risk of development of metabolic syndrome (MetS). The subjects were 1,677 Japanese male employees aged 36 to 57. Age, each component of MetS, serum uric acid, serum insulin, lifestyle factors, and occupational position were used for the analyses. The odds ratios (95% confidence intervals) of 2-shift work (n = 686) and 3-shift work (n = 99) against daytime work (n = 868) for the development of MetS, as defined by the National Cholesterol Education Program, were 1.43 (1.05, 1.95) and 0.72 (0.37, 1.41), respectively. When Japanese criteria were adopted for defining MetS, the corresponding odds ratios (95% confidence intervals) were 1.88 (1.29, 2.74) and 0.87 (0.39, 1.97), respectively. The results of the analyses suggested that 2-shift work was a risk factor for the development of metabolic syndrome. © 2014 Taylor & Francis Group, LLC.

DOI： 10.1080/19338244.2012.732123

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

Objectives This study examines whether precarious employment increases the risk of serious psychological distress (SPD) in a nationally representative cohort of Japanese middle-aged people. Methods From 2005-2009, we followed 8486 male and 6736 female participants (aged 50-59 years) in the Longitudinal Survey of Middle-aged and Elderly Persons. All individuals were employed and free of SPD, cardiovascular disease, and cancer at baseline. The participants were classified into two groups based on their baseline employment contract: precarious and full-time permanent work. SPD was assessed at each year during the study, using the K6 scale, a self-rated 6-item scale that screens for mood or anxiety disorders. We used discrete-time survival analysis, with a complementary log-log link, to examine the effect of precarious employment on SPD incidence. Results During a maximum follow-up period of four years, 374 men and 364 women developed SPD. Male precarious employees were more likely to develop SPD than male full-time permanent employees (hazard ratio 1.79, 95% confidence interval 1.28-2.51) in the full model, after adjusting for sociodemographic and occupational factors, cardiovascular disease risk, and K6 scores at baseline. By contrast, no significant association was observed among female employees. However, an analysis stratified by marital status revealed an association similar to that found among men but only among unmarried women. Conclusions The findings suggest that precarious employment is associated with double the risk of SPD incidence among middle-aged Japanese men and - when stratified by marital status - among unmarried women. This highlights a major gender difference in the association between precarious employment and risk of SPD.

DOI： 10.5271/sjweh.3442

Scopus

PubMed

researchmap

記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.81.57

researchmap

その他リンク： http://search.jamas.or.jp/link/ui/2015047537

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

Background: Excess salt intake increases blood pressure (BP). Identifying individuals with excess salt intake is, therefore, important for the prevention of hypertension. Aim: To examine the predictive value of subjective evaluation of salty foods intake for the risk of incident hypertension in a middle-aged population. Methods: A total of 970 non-hypertensive workers (mean age, 44 ± 6 years) was followed for a maximum period of 4 years, and their BP was measured annually. At baseline, all participants were asked about their subjective frequency of salty foods intake (seldom, sometimes or always), and they were divided into three groups according to their answers. Hypertension was defined as systolic/diastolic BP ≥ 140/90mmHg or use of antihypertensive medications. Results: There were no significant differences in the 4-year cumulative incident rate of hypertension among the 'seldom', 'sometimes' and 'always' groups (15.8%, 14.3% and 10.3%, respectively, log-rank test P = 0.44). In a multivariate Cox proportional hazards model, age, body mass index and the baseline BP category were independent predictors for developing hypertension, whereas the frequency of salty foods intake was not a predictor (adjusted hazard ratio (95% confidence interval), 0.99 (0.64-1.54) in the 'sometimes' group and 0.64 (0.33-1.28) in the 'always' group as compared with the 'seldom' group). Conclusion: The subjective evaluation of salty foods intake did not predict the 4-year risk of incident hypertension in this study population. Further investigations with a longer follow-up period are needed to clarify whether the present insignificant results are maintained for more than 4 years. © 2013 Royal Australasian College of Physicians.

DOI： 10.1111/imj.12259

Scopus

PubMed

researchmap

DOI： 10.1093/ajh/hpt128

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Background Relationships between plaque morphology on optical coherence tomography (OCT) and biomarker levels in the patients with acute coronary syndrome (ACS) have not been fully investigated. Methods ACS patients (n = 128) were prospectively enrolled and their plasma levels of soluble lectin-like oxidized LDL receptor-1 (sLOX-1), high-sensitivity C-reactive protein (hs-CRP), and high-sensitivity troponin T (hs-TnT) were measured. Another set of 20 patients with stable angina pectoris (SAP) without plaque rupture or erosion served as controls. Among 128 ACS patients, 75 patients underwent OCT procedure to evaluate culprit plaque morphology, and were categorized into two groups; ACS with plaque rupture (ruptured ACS; R-ACS, n = 54) and ACS without plaque rupture (non-ruptured ACS; N-ACS, n = 21). Results Levels of sLOX-1 (p < 0.001), hs-CRP (p = 0.048) and hs-TnT (p < 0.001) were significantly higher in R-ACS than SAP. Levels of sLOX-1 were also significantly higher in R-ACS than in N-ACS (p < 0.001); whereas levels of hs-CRP (p = 0.675), as well as those of hs-TnT (p = 0.055), were comparable between R-ACS and N-ACS. Comparison of receiver operating characteristic (ROC) curves among sLOX-1, hs-CRP and hs-TnT to differentiate R-ACS from N-ACS revealed that the area under the curve (AUC) values of sLOX-1, hs-CRP and hs-TnT were 0.782, 0.531 and 0.643, respectively. ROC curves, generated for these biomarkers, to differentiate ACS with thin-cap fibroatheroma (TCFA) from those without demonstrated that the AUC values of sLOX-1, hs-CRP and hs-TnT were 0.718, 0.506 and 0.524, respectively. Conclusion sLOX-1, but not hs-CRP or hs-TnT, can differentiate ACS with plaque rupture from those without, and ACS with TCFA from those without. © 2013 Elsevier Ireland Ltd.

DOI： 10.1016/j.ijcard.2013.04.110

Web of Science

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ijcard.2013.03.134

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

An enlarged arterial diameter is associated with an increased risk for cardiovascular disease. This study examined the relationship of noninvasively measured brachial artery cross-sectional area with cardiovascular risk factors and arterial stiffness in a middle-aged male population. Absolute volumetric changes of the brachial artery were measured with a newly developed oscillometric method during a general health examination in 387 men (mean age: 38±9 years) without known cardiovascular disease. Based on the measurement, the estimated area (eA) of the brachial artery at end-diastole was obtained. Brachial artery volume elastic modulus (VE) and brachial-ankle pulse wave velocity (baPWV) were simultaneously measured as indices of arterial stiffness by the same device. The relationships of eA with cardiovascular risk factors, including age, obesity, hypertension, dyslipidemia, impaired fasting glucose/diabetes mellitus (IFG/DM), hyperuricemia, smoking and their associated continuous variables, as well as VE and baPWV, were examined. Overall, the mean eA was 12.9±2.9 mm2. The eA was significantly higher in subjects with obesity, hypertension or IFG/DM than in those without each of these risk factors. In a multiple linear regression analysis, body mass index (β=0.31, P<0.001), age (β=0.25, P<0.001), systolic blood pressure (β=0.16, P=0.004) and pulse rate (β=-0.13, P=0.005) were independent determinants of eA. In contrast, neither VE nor baPWV were selected as independent determinants of eA. In conclusion, enlarged brachial artery cross-sectional area was significantly associated with cardiovascular risk factors such as age, body mass index and systolic blood pressure, but it was not associated with increased arterial stiffness. © 2013 The Japanese Society of Hypertension All rights reserved.

DOI： 10.1038/hr.2013.56

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Backgrounds: Left ventricular (LV) dyssynchrony reduces LV systolic function in patients with heart failure (HF). However, it remains unknown whether this relationship is independent of impaired LV myocardial perfusion. Methods and results: A total of 105 patients with chronic HF (age 71 ± 13 years; 71 men) were enrolled in the present study. 99mTc-sestamibi (MIBI) gated myocardial scintigraphy was performed at rest to assess LV myocardial perfusion as evaluated by the total defect score of perfusion Single Photon Emission Computed Tomography images (TDS-MIBI), LV systolic function as evaluated by LV ejection fraction (LVEF), and LV systolic dyssynchrony as evaluated by the maximal difference of time to end systole (MD-TES), which is the time lag between the earliest and the latest end systole among 17 LV segments analyzed with a novel program, "cardioGRAF". The mean ± SD (minimum and maximum range) of the MD-TES was 147.8 ± 117.5 (14.0-458.3) ms. The MD-TES was significantly higher in patients with LVEF < 45% (199.4 ± 117.6 ms) than in those with LVEF ≥ 45% (60.5 ± 41.2 ms, p < 0.001). In a multiple logistic regression analysis, the MD-TES showed an increased odds ratio for LVEF < 45% (2.46 [95% CI; 1.51-4.01] per increment in decile of MD-TES rank, p < 0.001), after adjusting for the TDS-MIBI, history of myocardial infarction, and other potential confounders. Conclusions: LV dyssynchrony is a significant determinant of LV systolic dysfunction in patients with HF, and this relationship is independent of impaired LV myocardial perfusion and history of myocardial infarction.

DOI： 10.1016/j.ijcard.2012.03.091

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

Objectives: The aim of this study was to examine the relationship between subjective evaluations of the frequency of salty food intake and both urinary sodium excretion and blood pressure (BP) in a middle-aged population. Methods: Urinary sodium and creatinine concentrations in a spot sample and brachial BP were measured in 419 subjects (mean age 37 ± 9 years, 385 men) during a health examination at a company in Kanagawa, Japan, 2011. Twenty-four-hour urinary sodium excretion was estimated from sodium and creatinine concentrations in the spot sample. The subjects were asked about the frequency of salty food intake on a self-reported questionnaire, choosing their answer from 'seldom', 'sometimes', or 'always' based on their own subjective evaluation. The amount of daily salt intake was converted from 24-h urinary sodium excretion. Results: The prevalence of high salt intake, defined as greater than the daily average salt intake of Japanese according to the National Health and Nutrition Survey in 2010, gradually increased from the 'seldom' to the 'sometimes', and then 'always' categories (10.3, 13.4, and 24.0 %, respectively; P = 0.013 for trend). The 24-h urinary sodium excretion among these groups also tended to be different; however, the differences did not reach a significantly significant level (145 ± 41, 152 ± 34, and 160 ± 40 mEq/day, respectively; P = 0.076). Both systolic and diastolic BP were similar among the groups. Conclusions: Although some of our findings raise the possibility of a relationship between a subjective evaluation of the frequency of salty food intake and urinary sodium excretion, further studies are needed to confirm the relationship. In contrast, no relationship with BP was found. © 2012 The Japanese Society for Hygiene.

DOI： 10.1007/s12199-012-0323-5

Scopus

PubMed

researchmap

担当区分：最終著者   掲載種別：研究論文（学術雑誌）  

Background: The second derivative of the finger photoplethysmogram (SDPTG) is an indicator of arterial stiffness. The present study was conducted to clarify the factor structure of indices of the SDPTG in combination with components of the metabolic syndrome (MetS), to elucidate the significance of the SDPTG among various cardiovascular risk factors. Methods: The SDPTG was determined in the second forefinger of the left hand in 1,055 male workers (mean age, 44.2±6.4 years). Among 4 waves of SDPTG components, the ratios of the height of the "a" wave to that of the "b" and "d" waves were expressed as b/a and d/a, and used as SDPTG indices for the analysis. Results: Principal axis factoring analysis was conducted using age, SDPTG indices, components of MetS, and the serum levels of C-reactive protein (CRP) and uric acid. Three factors were extracted, and the SDPTG indices were categorized in combination with age as the third factor. Metabolic components and the SDPTG indices were independently categorized. These three factors explained 44.4% of the total variation. Multiple logistic regression analysis revealed age, d/a, serum uric acid, serum CRP, and regular exercise as independent determinants of the risk of MetS. The odds ratios (95% confidence intervals) were 1.08 (1.04 to 1.11), 0.10 (0.01 to 0.73), 1.24 (1.06 to 1.44), 3.59 (2.37 to 5.42), and 0.48 (0.28 to 0.82), respectively. Conclusion: The SDPTG indices were categorized in combination with age, and they differed in characteristics from components of MetS or inflammatory markers. In addition, this cross-sectional study also revealed decrease of the d/a as a risk factor for the development of MetS. © 2013 Korean Diabetes Association.

DOI： 10.4093/dmj.2013.37.1.40

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

Background: The association between inflammatory markers and the combination of the smoking status plus a number of components of the metabolic syndrome was not fully evaluated in male Japanese subjects. Objectives: To demonstrate the association between inflammatory markers and the number of components of the metabolic syndrome by considering smoking status. Patients and Methods: A total of 3,017 male subjects (1,047 current smokers, 1,970 non-smokers) were included. Metabolic syndrome (MetS) was defined by the criteria of the National Cholesterol Education Program Adult Treatment Panel III. The smoking status was categorized in a binary manner into current smokers or non-smokers. Results: The geometric mean value of the serum CRP increased linearly as the number of components of MetS increased (P &#60; 0.05). In contrast, the mean values of the total WBC, neutrophil, lymphocyte and monocyte counts showed peak values when the number of MetS components was 3 or 4. The log-transformed serum CRP levels and the WBC counts were significantly correlated with one another (P &#60; 0.001), but Pearson's correlation coefficient was under 0.3 for current smokers. Conclusions: Among several inflammatory markers, the serum CRP predominantly changed linearly as the number of MetS increased regardless of smoking status. © 2013, Research Institute For Endocrine Sciences and Iran Endocrine Society; Published by Kowsar Corp.

DOI： 10.5812/ijem.8403

Scopus

researchmap

記述言語：日本語   出版者・発行元：ライフサイエンス出版(株)  

オシロメトリック法血圧脈波検査装置を用いて、上腕動脈推定内腔断面積(A)を測定した。まず、Study 1として健常成人ボランティア9例を対象に、Aの再現性と超音波法で測定した上腕動脈径とAとの関連性を検討し、更に上腕動脈容積弾性率(V)の測定も行い再現性を検討した。次いで、Study 2として冠動脈疾患の疑い、またはその疑いのある29例を対象に、超音波法で測定した上腕動脈径とAとの関連性を検討した。その結果、Study 1では、Aの連続2回測定値における変動係数は18測定中17測定が10%未満で、全18測定における変動係数の平均は3.6%であった。Bland-Altmanプロットでは、全連続測定において誤差の許容範囲内であった。一方で、VについてはBland-Altmanプロットでは誤差は許容範囲内であったが、連続測定では変動係数の平均は8.3%であった。本機器により算出した上腕動脈面積の正確性を検討するため、超音波法における上腕動脈径とAおよびAから算出した上腕動脈径との相関関係を検討した結果、Study 1では超音波法における上腕動脈径とA、およびAから算出した上腕動脈径との間に高い相関関係を認めたが、Study 2ではその相関係数は低下していた。

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J01759&link_issn=&doc_id=20121206110015&doc_link_id=issn%3D0289-8020%26volume%3D33%26issue%3D11%26spage%3D1701&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0289-8020%26volume%3D33%26issue%3D11%26spage%3D1701&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

担当区分：最終著者  

DOI： 10.1111/j.1365-2850.2012.01936.x

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Background: Sleep disordered breathing (SDB) is highly prevalent in patients with cardiovascular disease, although it is not clear whether SDB has any link to coronary atherosclerotic burden in patients with stable coronary artery disease (CAD). This study sought to analyze the links between SDB, coronary atherosclerotic burden, and cardiac biomarkers in stable CAD patients. Methods and results: We studied 83 consecutive patients who underwent coronary angiography or scheduled percutaneous coronary intervention. SDB was evaluated by an ambulatory polysomnographic monitoring device. Coronary atherosclerotic burden was evaluated by the Gensini score, and myocardial stress/injury were assessed by measuring plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity troponin T (hs-TnT). Patients with an apnea hypopnea index (AHI). ≧ 15. events/h (n= 32) showed significantly higher Gensini score (35.7. ± 38.0 vs 20.1. ± 19.7, p= 0.033) than those with AHI. < 15. The higher AHI group showed significantly higher NT-proBNP (275.8. ± 402.6. pg/ml vs 131.9. ± 146.3. pg/ml, p= 0.047) and hs-TnT levels (0.011. ± 0.005. ng/ml vs 0.008. ± 0.003. ng/ml, p= 0.015). Furthermore it was revealed that AHI significantly correlated with the Gensini score (r= 0.253, p= 0.036), NT-proBNP (r= 0.266, p= 0.027), and hs-TnT (r= 0.274, p= 0.023), and multiple stepwise linear regression analysis revealed that AHI (β = 0.257, p= 0.029) and history of smoking (β. = 0.244, p= 0.038) were independently correlated with Gensini score among clinical and SDB-related parameters. Conclusions: Severity of SDB has a significant link to the severity of coronary atherosclerotic burden, which also reflected elevated NT-proBNP and hs-TnT as silent myocardial ischemia and minute myocardial injury even in stable CAD patients. © 2012 Japanese College of Cardiology.

DOI： 10.1016/j.jjcc.2012.03.003

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Objective: metabolic syndrome (MetS) is known to be associated with an increased risk for cerebro- as well as cardio-vascular disease. Prediction of carotid atherosclerosis by components of MetS, serum C-reactive protein, aging and related factors was conducted for Japanese inhabitants. Methods: A total of 887 subjects (761 males, 126 females) were included in the present study. Early atherosclerosis was assessed by measurement of the intima-media thickness of the common carotid arteries. Results: The carotid arterial intima-media thickness on both the right and left sides significantly increased as the number of components of MetS increased. The maximum intima-media thickness values in the right (left) carotid arteries in the male and female subjects who fulfilled the criteria for MetS were 0.65±0.18 (0.66±0.17) mm and 0.58±0.12 (0.59±0.11) mm, respectively. After adjustment for several factors, the intima-media thickness related significantly with aging, some components of MetS and serum C-reactive protein by multiple regression analysis. β-coefficient of age was largest, presenting 0.457 in right side and 0.479 in left side. Conclusions: Aging, metabolic components and serum C-reactive protein are independent predictors of intima-media thickness in subjects. © 2012 Informa UK, Ltd.

DOI： 10.3109/13685538.2011.593656

Scopus

PubMed

researchmap

担当区分：責任著者   掲載種別：研究論文（学術雑誌）  

Background : The present study examined the reproducibility and accuracy of the measurement of brachial artery cross-sectional area based on a newly developed oscillometric method in two distinct studies. Methods : The Study 1 and Study 2 consisted of 9 healthy subjects (mean age 32±7 years, 7 males) and 29 patients with definitive or suspected coronary heart disease (mean age 64±10 years, 19 males), respectively. In both studies, brachial artery diameter was firstly measured with ultrasonography and then estimated area(eA) of the brachial artery was measured with the new oscillometric device, Health Chronos TM-2771 prototype (A&D Company, Tokyo, Japan). The reproducibility of the 2 consecutive measurements of eA was examined in the Study 1. The correlation between eA and brachial artery diameter by ultrasonography was examined in both studies. Results : In the Study 1, the mean coefficient of variation of eA was 3.6%. A close correlation was found between eA and brachial artery diameter by ultrasonography (r = 0.93, p < 0.001). The regression equation between eA-based brachial artery diameter (X) and brachial artery diameter by ultrasonography (Y) was expressed as Y = 1.05X-0.46. In the Study 2, the correlation coefficient between eA and brachial artery diameter by ultrasonography was 0.75 (p < 0.001). Conclusions : An acceptable reproducibility and accuracy of the oscillometric measurement of eA was observed in healthy subjects. In contrast, the correlation between eA and brachial artery diameter by ultrasonography appeared to be reduced in patients with definitive or suspected coronary heart disease.

Scopus

researchmap

掲載種別：論文集(書籍)内論文  

To investigate the effects of forest environments on cardiovascular and metabolic parameters, sixteen healthy male subjects (mean age: 57.4±11.6 years) were selected after obtaining informed consent. The subjects took day trips to a forest park in the suburbs of Tokyo and to an urban area of Tokyo as a control in September 2010. On both trips, they walked for two hours in the morning and afternoon on a Sunday. Blood and urine were sampled on the morning before each trip and after each trip. Blood pressure was measured on the morning (0800) before each trip, at noon (1300), in the afternoon (1600) during each trip, and on the morning (0800) after each trip. The day trip to the forest park significantly reduced blood pressure and urinary noradrenaline and dopamine levels and significantly increased serum adiponectin and dehydroepiandrosterone sulfate (DHEA-S) levels. Walking exercise also reduced the levels of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), blood HbA1c and urinary dopamine. However, forest environments did not affect the levels of triglycerides, total Cho, LDL-Cho, HDL-Cho, RLP-Cho, insulin, or hs-CRP in serum, blood glucose, or hematological parameters. Taken together, habitual walking in forest environments may lower blood pressure by reducing sympathetic nerve activity and have beneficial effects on blood adiponectin and DHEA-S levels, and habitual walking exercise may have beneficial effects on blood NT-proBNP levels.© 2013 by Nova Science Publishers, Inc. All rights reserved.

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

We previously found that forest environments reduced stress hormones such as adrenaline and noradrenaline and showed the relaxing eVect both in male and female subjects. In the present study, we investigated the eVects of walking under forest environments on cardiovascular and metabolic parameters. Sixteen healthy male subjects (mean age 57.4 ± 11.6 years) were selected after obtaining informed consent. The subjects took day trips to a forest park in the suburbs of Tokyo and to an urban area of Tokyo as a control in September 2010. On both trips, they walked for 2 h in the morning and afternoon on a Sunday. Blood and urine were sampled on the morning before each trip and after each trip. Blood pressure was measured on the morning (0800) before each trip, at noon (1300), in the afternoon (1600) during each trip, and on the morning (0800) after each trip. The day trip to the forest park signiWcantly reduced blood pressure and urinary noradrenaline and dopamine levels and signiWcantly increased serum adiponectin and dehydroepiandrosterone sulfate (DHEA-S) levels. Walking exercise also reduced the levels of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and urinary dopamine. Taken together, habitual walking in forest environments may lower blood pressure by reducing sympathetic nerve activity and have beneWcial eVects on blood adiponectin and DHEA-S levels, and habitual walking exercise may have beneWcial eVects on blood NT-proBNP levels. © 2011 Springer-Verlag.

DOI： 10.1007/s00421-011-1918-z

Web of Science

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ijcard.2011.06.095

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

It is important to make a prompt diagnosis of metabolic syndrome (MetS) in order to prevent the development of cardio-/cerebro- vascular diseases and diabetes mellitus (DM). The authors estimated the risk of development of DM by the presence/absence of MetS and age groups. Methods. A cross-sectional study of subjects undergoing intensive health examination was conducted (3149 men aged 30-69 years). Diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Expert Panel (NCEP). Results. The prevalence of DM occurring in association with MetS increased with age; it was 11.9% in subjects with MetS in their 30s, it was 19.8% in subjects with MetS in their 60s. The prevalence of DM among subjects who had one or two components of MetS also increased with age. There was a significant progressive increase of the odds ratio in subjects in their 30s, 40s, 50s and 60s who were judged as having MetS; significant increase of the odds ratio was seen in subjects in their 60s, even in those who were not judged as having MetS. Conclusions. Subjects with MetS show a high prevalence of DM, and the prevalence increased with age in the subjects. © 2011 Informa UK, Ltd.

DOI： 10.3109/13685538.2011.565092

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Morning hypertension is a risk for stroke and cardiovascular events. We herein treated hypertensive patients attending an outpatient clinic with cilnidipine and assessed its efficacy against morning hypertension. Cilnidipine was administered to treat 35 patients with hypertension. In addition to their office blood pressure (BP), home BP in 20 patients and 24-hour ambulatory blood pressure monitoring (ABPM) in 5 patients were evaluated. The values of home BP in the morning (M) and the evening (E) were obtained, and ME average ([M+E]/2) and ME difference (M-E) as indicators of morning hypertension were calculated. The patients were divided into four groups based on distribution of ME average and ME difference, a normal blood pressure group (Group I), a morning surge type group (Group II), a sustained hypertension group (Group III), and a morning predominant hypertension group (Group IV). Systolic and diastolic office BP and home BP significantly decreased by cilnidipine. The distribution of patients in groups I, II, III, and IV significantly improved between before treatment (0%, 0%, 72.8%, and 27.2%, respectively) and after 12 weeks of treatment (56.3%, 12.5%, 31.1%, and 0%, respectively) (p=0.020). Systolic BP measured from 6 a.m. to 9 a.m. by ABPM significantly decreased in comparison with before treatment (p = 0.001). In conclusions, a single morning dose of cilnidipine improved morning hypertension as well as office BP, suggesting that it is a very useful antihypertensive drug for the treatment of morning hypertension, which requires strict management.

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INFORMA HEALTHCARE  

Introduction. The relationship among lifestyle, aging and psychological wellbeing was evaluated in Japanese working men. Methods. Self-administered questionnaire on six lifestyle factors and the General Health Questionnaire 12-item version (GHQ12) were administered to 3306 male workers. Health practice index (HPI) was calculated as a desirable lifestyle score by summing up each binary lifestyle score (0, 1), ranging from 0 to 6. To check validity of the study outcome, the authors repeated twice with 1 year interval. HPI was categorised into three groups by the score of 0-2, 3-4 and 5-6. Results. The number of subjects categorised by HPI was 532, 1967 and 807, respectively. The mean value of GHQ12 significantly decreased as the HPI increased by adjusting age. Multiple regression analysis was conducted to predict GHQ12 by six lifestyle scores, and age, sleep, night snacking and exercise were significantly related to GHQ12. Multiple logistic regression analysis was conducted and age in 50s, two-shift work, sleep, night snacking and exercise were significantly associated with GHQ12. Conclusion. Although cause-effect relationship cannot make clear, some of desirable health practices and aging were closely related to psychological wellbeing judged by GHQ12. © 2011 Informa UK, Ltd.

DOI： 10.3109/13685538.2010.493588

Web of Science

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Aims: There is an ethnic difference of obesity index to diagnose metabolic syndrome. The authors explored the optimal cut-off levels for body mass index (BMI) and waist circumference (WC) in relation to each component of metabolic syndrome. Materials and methods: Receiver operating characteristics (ROC) analysis was used to determine the optimal cut-off levels for each component of metabolic syndrome. This study included 4572 workers aged 42.5 ± 9.9 years. Results: The optimal BMI cut-off values for diabetes mellitus, hypertension or dyslipidemia varied from 23.0 to 24.3 kg/m2. As for WC, the optimal cut-off values varied from 83.0 to 83.7 cm. The optimal BMI cut-off values relating with one to three components of metabolic syndrome varied from 23.2 to 25.3 kg/m2. As for WC, the optimal cut-off values varied from 83.0 to 85.0 cm. Pair-wise comparison of ROC curves showed that WC has an advantage in relation to metabolic syndrome and its components compared with BMI. By logistic regression analysis, odds ratios of obesity indices for hypertension, dyslipidemia or the number of metabolic component were all significantly increased. As for diabetes mellitus, odds ratios of BMI ≥25 and WC ≥85 significantly increased, respectively. Conclusions: Japanese criteria of obesity in metabolic syndrome in man may be appropriate for diabetes mellitus. Ethnic difference in criteria of obesity in Asian metabolic syndrome exists, and mutual comparisons in the prevalence of metabolic syndrome have a difficulty to conduct. © 2010 Diabetes India. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.dsx.2010.05.012

Scopus

PubMed

researchmap

記述言語：英語   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Variant angina is a form of angina pectoris that shows transient ST-segment elevation on electrocardiogram during an attack of chest pain. Ischemic episodes of variant angina show circadian variation and often occur at rest from midnight to early morning. Ischemic episodes also occur during mild exercise in the early morning. However, they are not usually induced by strenuous exercise in the afternoon. Other important clinical features of variant angina include the high frequency of asymptomatic ischemic episodes and the syncope that sometimes occur during the ischemic episodes. Syncope is due to severe arrhythmias, including ventricular tachycardia, ventricular fibrillation, and high-degree atrioventricular block. Coronary artery spasm is the mechanism of ischemic episodes in variant angina. The incidence of coronary artery spasm shows a racial difference and is higher in Japanese than in Caucasians. Coronary arteriograms are normal or near-normal in most Japanese patients with variant angina. Deficient basal release of nitric oxide (NO) due to endothelial dysfunction, and enhanced vascular smooth muscle contractility with the involvement of the Rho/Rho-kinase pathway are reported to play important roles in the pathogenesis of coronary artery spasm. Other precipitating factors of coronary artery spasm include imbalance in autonomic nervous activity, increased oxidative stress, chronic low-grade inflammation, magnesium deficiency, and genetic susceptibility. The genetic risk factors associated with coronary artery spasm include gene polymorphisms of endothelial NO synthase (NOS), paraoxonase, and other genes. Calcium channel blockers are extremely effective in preventing coronary spasm. The long-acting nitrate, nicorandil, and Rho-kinase inhibitor are also useful for inhibiting coronary artery spasm. Because variant angina can lead to acute myocardial infarction, fatal arrhythmias, and sudden death, early treatment is important. The prognosis of patients with variant angina is favorable, if early complications can be overcome. However, because coronary artery spasm cannot be suppressed in some patients, even with multiple medications, medications to suppress intractable coronary artery spasm must be developed.

DOI： 10.1272/jnms.78.4

Web of Science

Scopus

PubMed

researchmap

担当区分：最終著者   掲載種別：研究論文（学術雑誌）  

Objective: Subjects with higher occupational position are speculated to have higher ability to handle with stress, and they were less affected by job stress. This study focused on the relationship between job satisfaction and three sub-scales of a brief job stress questionnaire (BJSQ) related to workload. Participants and Methods: This self-administered questionnaire was distributed to 371 employees of a company, and all the workers sent back their responses. Among the 57 items graded on a 4-point Likert-type scale to measure job stressors, psychophysical complaints, and support for workers, the authors studied the influence of quantitative and qualitative job overload (six items), job control (three items), and support port (six items). The job satisfaction score estimated on a 4-point Likert-type scale was also used in relation to job stress determined using a 15-item scale from the BJSQ based on demand-control-support model. Occupational positions were classified into directors, managers, and general workers, and the content of job was classified into clerical workers, skilled technicians, and unskilled manual workers. Results: All the scales on job stress presented acceptable alpha coefficients reflecting high internal consistency (job demand: 0.855, job control: 0.644, and support: 0.878, respectively). Principal axis factor analysis was conducted, and three factors were extracted; support, job demand and job control. There was a significant difference in the mean score among four groups divided by the job satisfaction level as evaluated by Dunnett’s multiple comparison, and members who were dissatisfied with their job showed a high job demand, limited job control, and poor support. The mean score of support for managers were significantly higher (lower support) than that for general workers. The logistic regression analysis revealed that job control and support contributed significantly to job satisfaction. In addition, unskilled manual workers showed significantly higher job dissatisfaction compared with clerical workers. Conclusions: Worsening of job satisfaction was related to poor job control and lack of support. Strategies to alleviate job stress are therefore urgently needed. © 2011 - IOS Press and the authors. All rights reserved.

DOI： 10.3233/WOR-2011-1251

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Background: The aim of this study was to examine the association between serum insulin levels and components of the metabolic syndrome (MetS) in working women. Methods: The target subjects were 141 working women. Serum triglyceride, HDL cholesterol, uric acid, plasma insulin and plasma glucose were measured in addition to waist circumference and blood pressure. Results: MetS was diagnosed based on the modified criteria of the International Diabetes Federation, and was present in 7.1% (10/141) of the study subjects. Stepwise multiple regression analysis showed that some components of MetS were significantly associated with log-transformed values of the serum insulin. The standardized regression coefficient for the waist circumference, high density lipoprotein cholesterol, systolic blood pressure and age were 0.238, -0.333, 0.309 and -0.156, respectively. Conclusions: A statistically significant relationship existed between the components of MetS and the serum insulin levels in working women. © 2010 Diabetes India.

DOI： 10.1016/j.dsx.2010.12.005

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Aim: It remains unclear whether the decrease in the ADMA level associated with statin treatment results from the LDL-C-lowering effect or the pleiotropic effects of statins. A prospective, controlled study was conducted to examine whether statin treatment affects serum ADMA concentrations in ischemic stroke patients. Methods: Consecutive outpatients with non-cardiogenic ischemic stroke who had never been treated with statins and whose LDL-cholesterol level was higher than 140 mg/dL were enrolled and compared with control patients whose LDL-cholesterol level was lower than 140 mg/dL. Overall, 114 patients were enrolled in the study (56 and 58 in statin-treated and non-statin-treated groups, respectively). Patients in the statin group were treated with pravastatin 10 mg/day (n = 15), fluvastatin 20 mg/day (n = 14), pitavastatin 1 mg/day (n = 14), or atorvastatin 10 mg/day (n = 13). Results: The serum ADMA concentration and LDL-C level were significantly decreased by statin treatment (p = 0.003 and p<0.001, respectively), and the ADMA concentration in subjects treated with statins was significantly lower than that of the control (p = 0.028). Multiple linear regression analysis showed that age (β= 0.26, p<0.05) and statin use (β= 0.20, p<0.05) were independently associated with the ADMA level. Conclusions: A significant relation between statin treatment and decreased levels of ADMA was demonstrated in ischemic stroke patients with an adequately controlled lipid profile, suggesting the statin treatment might prevent atherosclerotic disease in ischemic stroke patients through suppression of ADMA concentration.

DOI： 10.5551/jat.5553

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

DOI： 10.1253/circj.CJ-10-0526

Web of Science

Scopus

PubMed

researchmap

担当区分：最終著者   記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：IOS PRESS  

Objective: It has been suggested that the presence of a depressive state is a predictor of increase of the body weight. However, to precisely understand the nature of this relationship, the data should be controlled for other factors that can also be associated with weight gain. Methods and Participants: To test the hypothesis that the presence of a depressive state is associated with future weight gain, a 4-year prospective occupation-based cohort study was conducted in male adult workers (N=1730) at a railway company. Following the initial screening, follow-up information was obtained via a legally required annual health examination. The presence of a depressive state was identified using the Zung Self-Rating Depression Scale (SDS). The weight of each participant was measured to the nearest kilogram. Multiple logistic regression analysis was used to test the association between the depressive state and a weight gain of 4 kg or more over the 4-year study period after controlling for potentially confounding variables such as the age, smoking status, alcohol intake status, and physical activity. Results: A weight gain of 4 kg or more over the 4-year study period was significantly associated with the depressive state, even after controlling for confounding variables (p < 0.05). Short-term longitudinal analysis also revealed an association between the depressive state and subsequent increase of the body weight. Conclusion: Since the depressive state was demonstrated to be an important risk factor for increase of the body weight, further research on depression should be conducted with a view to providing effective health education. © 2011 - IOS Press and the authors. All rights reserved.

DOI： 10.3233/WOR-2011-1114

Web of Science

Scopus

PubMed

researchmap

担当区分：筆頭著者  

DOI： 10.1016/j.ahj.2010.09.010

Scopus

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

Cigarette smoking impairs arterial function and promotes atherosclerosis. However, whether smoking status is associated with cardiac overload has not yet been fully examined, particularly from an epidemiologic viewpoint. The present study examined the relation of smoking status to serum levels of N-terminal probrain natriuretic peptide (NTpro-BNP), a marker of cardiac overload, in middle-aged men without overt cardiovascular disease. Serum NTpro-BNP levels were measured in a work-site based population of 969 men (mean age 44 ± 6 years) who did not have any history or presence of cardiovascular disease. Smoking status was evaluated by self-reported questionnaire. Four hundred fifty-nine, 222, and 288 subjects were never, former, and current smokers, respectively. NTpro-BNP levels were significantly higher in current smokers (21.7 ± 2.3 pg/ml) than in never smokers (17.9 ± 2.1 pg/ml, p <0.001). This significant difference was maintained even after adjusting for age, obesity, heart rate, hypertension, dyslipidemia, impaired fasting glucose/diabetes mellitus, left ventricular hypertrophy, estimated glomerular filtration rate, high-sensitivity C-reactive protein, alcohol consumption, and regular exercise. Current smokers had an increased odds ratio (3.04, 95% confidence interval 1.64 to 5.61, p <0.001) for elevated NTpro-BNP (>54.5 pg/ml) compared to never smokers, even after adjusting for the studied variables. In contrast, former smokers did not show a significantly increased odds ratio for elevated NTpro-BNP. NTpro-BNP levels showed a weak, but significant negative correlation with duration of smoking cessation (partial r = -0.15, p = 0.034) in former smokers. In conclusion, these results suggest that cigarette smoking increases cardiac overload, whereas smoking cessation ameliorates these conditions. © 2010 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2010.06.075

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Aims: The prevalence of glucose intolerance in the Japanese adult population is increasing. In this study, the associated factors including lifestyles with glucose intolerance and its metabolism were explored. Methods: A cross-sectional study was conducted in 2008. The sample included 3203 working men aged 35-59 years. Age, six lifestyle-related factors, and metabolic components were used as variables to calculate the odds ratio for glucose intolerance, which were defined if his fasting plasma glucose was ≥110 mg/dL and <126 mg/dL. Results: The prevalence of glucose intolerance was 8.4%, and it increased with 5-year interval of age (2.2, 5.0, 10.4, 15.2, and 17.5%, respectively). Odds ratios (95% confidence interval) of age, obesity, hypertension, dyslipidemia, and no current smoking for glucose intolerance were 1.11 (1.09-1.13), 1.66 (1.31-2.11), 1.90 (1.47-2.47), 1.86 (1.46-2.36), and 0.79 (0.62-0.998), respectively. In contrast, the odds ratios of drinking, sleeping, exercise, and dietary habit did not reach the significance level, although multiple regression analysis presented that subjects with regular exercise showed significantly lower serum insulin level. Conclusions: The risk of glucose intolerance was significantly correlated with obesity, high blood pressure, dyslipidemia and smoking habit. However, other lifestyle factors were not significantly associated with glucose intolerance. © 2010 Diabetes India. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.dsx.2010.05.015

Scopus

researchmap

担当区分：最終著者  

DOI： 10.1111/j.1751-7176.2010.00345.x

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Introduction: Statistical information regarding the prevalence of metabolic syndrome among a wide age range of workers is insufficient. Methods: A total of 4278 men between the ages of 20 and 59 years participated in the study. Metabolic syndrome was diagnosed according to the International Diabetes Federation (IDF) and the National Cholesterol Education Program (NCEP) III criteria. Results: Overall, the prevalences of metabolic syndrome according to the IDF and NCEPIII criteria were 13.6 and 14.8, respectively. The prevalence of metabolic syndrome according to the IDF (NCEPIII) criteria among workers in their 20s, 30s, 40s, and 50s were 4.8 (6.1), 9.9 (12.2), 18.4 (21.6) and 25.8 (34.0), respectively. A plot of the prevalence of metabolic syndrome according to the NCEPIII criteria versus age had a steep gradient and increased sharply for men in their 50s. In contrast, a plot of the prevalence of metabolic syndrome according to the IDF criteria versus age increased in a linear manner. Conclusion.The prevalence of metabolic syndrome increased among workers according to age, but the increasing trend and the absolute prevalence of metabolic syndrome differed according to the two sets of diagnostic criteria used in this study. © 2010 Informa UK Ltd.

DOI： 10.3109/13685531003586983

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Introduction: Shift work has been reported to be associated with an increase in the metabolic syndrome (MetS). To clarify the association between the type of shift work and the risk of MetS, a cross-sectional field survey was conducted after adjusting for age and lifestyle factors. Methods: The subjects were 3007 Japanese males, aged 3464 years old, who were employees (1700 day and 1307 shift workers) of a car-manufacturing company. The standard Japanese criteria for the diagnosis of MetS was used. Age, smoking habit, drinking habit, sleeping habit and exercise habit were used as the independent variables. Results: The prevalence of MetS in the day workers, two-shift workers, and three-shift workers were 13.8 (234/1700), 10.7 (120/1125) and 17.6 (32/182), respectively. There was a significant difference in the prevalence between the two-shift workers and the day workers. Estimation of the odds ratios (95 confidence intervals) of age, two-shift work and habitual exercise for MetS were 1.03 (1.011.04), 0.77 (0.610.98) and 0.64 (0.510.81), respectively. Conclusion.Two-shift work was associated with lower risk of MetS, which is not in accordance with past reports. This finding should therefore be re-analysed, including investigation of the job content in each group. © 2010 Informa UK Ltd.

DOI： 10.3109/13685530903536692

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Background: Serum uric acid and hematological parameters play a significant role for cardiovascular disease (CVD). The metabolic syndrome (MetS) is associated with CVD, but the relationship between such blood parameters and MetS has not yet been precisely investigated in healthy workers. Methods: A total of 1088 male workers in a pharmaceutical company, aged 30-59 years with mean age of 43.2, were recruited. They participated in annual health examination in 2009. MetS was diagnosed according to the NCEP-ATP III criteria with modification on waist circumference. The relationships between blood parameters and MetS were analyzed according to four groups stratified by the number of components on MetS (0, 1, 2 and 3-5) in combination with age. Results: There was a significant trend of increase of variables such as hematocrit, white blood cell count (WBC), platelet count and serum uric acid as the number of components on MetS increased (p < 0.05). Among them, there was a significant difference in the mean value except platelet count between a group of MetS and other groups. Furthermore, serum uric acid, WBC count and age were significantly associated with MetS by logistic regression analysis. Odds ratios and 95% confidence intervals in parentheses of uric acid and WBC against MetS were 1.47 (1.28-1.69) and 1.34 (1.21-1.49), respectively. Conclusions: Serum uric acid and WBC were associated with MetS, and such blood parameters increased as the number of MetS components increased in Japanese male workers. © 2010 Diabetes India. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.dsx.2010.05.016

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

Background: Asymmetric dimethylarginine (ADMA) affects vascular function by blocking nitric oxide synthesis. We examined the relationship of ADMA concentration to vascular risk factors in subjects who have undergone annual medical check-up. Methods: ADMA concentration, lipid profile and vascular risk factors were assessed during an annual medical examination in 116 subjects (mean age 58.7 years). Univariate and multivariate analyses were carried out to assess factors associated with ADMA concentration. ADMA concentration was also assessed in 50 age-matched patients with ischemic stroke. Results: Mean serum ADMA concentration was significantly higher in the ischemic stroke patients than the medical check-up subjects (0.461 ± 0.076 versus 0.433 ± 0.056 μmol/l; P = 0.022). Univariate analysis showed that ADMA concentration in the medical check-up subjects was significantly associated with age, hypertension, dyslipidemia, fasting blood glucose, total and LDL cholesterol concentrations. Multiple stepwise linear regression analysis showed that hypertension (β = 0.25, P = 0.008) and dyslipidemia (β = 0.19, P = 0.048) were significant independent determinants of ADMA concentration. ADMA concentration increased progressively with number of vascular risk factors, with a significant (P = 0.001) difference between subjects with no risk factors and subjects with ≥ 2 risk factors. Conclusions: Serum ADMA concentration was significantly associated with vascular risk factors in subjects undergoing routine medical check-up. ADMA concentration warrants further examination as a possible marker of future development of ischemic stroke. © 2009 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2009.12.020

Scopus

PubMed

researchmap

担当区分：筆頭著者  

DOI： 10.1253/circj.CJ-09-0805

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Objective: This study was intended to identify significant determinant factors of insulin resistance. Methods: Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-R) and was calculated as "Fasting plasma glucose × Fasting serum insulin)/405". The target subjects were 3008 working men. The serum lipid profiles, uric acid level, insulin level, plasma glucose level, hemoglobin A1C level, and blood pressure, in addition to the waist circumference or body mass index, were also measured. A stepwise multiple regression analysis was performed using log-transformed values of HOMA-R as the dependent variable. Results: The standardized regression coefficient for waist circumference was about six times larger than that for hemoglobin A1c (0.45 and 0.08, respectively). The standardized regression coefficients for the other factors were 0.15 for diastolic blood pressure, 0.10 for the low-density lipoprotein cholesterol level, -0.06 for age, -0.04 for habitual exercise, 0.14 for no habitual drinking, and 0.07 for no smoking. When body mass index was substituted for waist circumference, almost the same results were obtained. The adverse effects of no smoking and no habitual drinking on the HOMA-R score might be explained, at least in part, by the relation of these factors with obesity. Regular exercise had a protective effect on lowering insulin resistance. Conclusions: A close relation exists between obesity-related indices (waist circumference and body mass index) and insulin resistance, independent of age and other vascular risk factors in Japanese working men. © 2009 Asian Oceanian Association for the Study of Obesity.

DOI： 10.1016/j.orcp.2009.07.001

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

Background: Smoking cessation is one of the primary targets for risk reduction of atherosclerotic cardiovascular disease. It also leads to the prevention of workers' illness or disability. Validation of a 100-point scale to evaluate perceived tobacco dependence was conducted using a 10-item questionnaire (the Tobacco Dependence Screener; TDS), a 6-item questionnaire (Fagerstrom Test for Nicotine Dependence; FTND), and determining the salivary levels of cotinine at Japanese workplaces. Methods: A total of 1023 male smokers completed the TDS and FTND and scored themselves on the 100-point scale for tobacco dependence (Study 1). Of the subjects participating in Study 1, 282 male smokers from one workplace presented saliva samples, and the salivary nicotine and cotinine levels were determined by high-performance liquid chromatography (Study 2). After conducting principal axis factor analysis, multiple regression analysis was employed to clarify the association between the score on the 100-point scale for perceived tobacco dependence and several factors such as age, the TDS score, the FTND score, and the salivary cotinine level. Results: The mean age for the subjects was 40.3 years. The mean salivary cotinine level was 235.4 ng/ml, and it increased significantly with increase in the number of cigarettes smoked per day. Cronbach's alpha coefficients for the TDS and FTND were 0.77 and 0.64, respectively. A ROC analysis indicated a cutoff point for the score on the 100-point scale of 61, which yielded a positive result on the TDS (≥ 5) with 65.7% sensitivity and 70.0% specificity. When FTND ≥ 4 was adopted as the gold standard, the sensitivity and specificity became 68.7% and 73.2%, respectively. Three factors were extracted by principal axis factor analysis, explaining 42% of the total variation. Multiple regression analysis revealed that the score on the 100-point scale for evaluating tobacco dependence was positively associated with the TDS and FTND scores, and negatively associated with the age. The adjusted multiple correlation coefficient was 0.262. Conclusions: The 100-point scale, which is a simple and easy tool to evaluate tobacco dependence, must be used in combination with other tobacco dependence questionnaires such as TDS and FTND and also the salivary cotinine level as a biological marker of tobacco exposure to conduct multi-dimensional education to promote smoking cessation. © 2010-IOS Press and the authors. All rights reserved.

DOI： 10.3233/WOR-2010-0970

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

Aim: The present study examined the association between the radial augmentation index (AI), a marker of arterial wave reflection, and the MEGA risk prediction score (MEGA score), an indicator of coronary heart disease (CHD) risk, in middle-aged men with mild to moderate hypercholesterolemia. Methods: Radial AI was measured during a company health examination in 266 men (age: 47±5 years) with total cholesterol levels ranging 220-270 mg/dL who were not taking antihypertensive, lipid-lowering, or antidiabetic agents. The MEGA score was calculated based on sex, age, low-and high-density lipoprotein cholesterol, blood pressure, glucose level, and smoking status. The higher MEGA score indicates increased CHD risk. A MEGA score ≥ 22 corresponds to a 5-year CHD risk ≥ 2.5% and we defined a MEGA score ≥ 22 as a high estimated CHD risk. Results: The mean AI was 74.4±12.6%. A high estimated CHD risk was seen in 32 subjects (12.0%). After adjusting for height and heart rate, the AI was higher in subjects with a high estimated CHD risk (81.5±10.6%) than in those without (73.4±10.4%, p<0.001). The odds ratio for high estimated CHD risk in the highest tertile of AI was 8.14 (p=0.002) in comparison to the lowest tertile, after adjusting for multiple potential confounders which did not constitute the MEGA score. Conclusion: The radial AI was positively associated with the estimated risk of CHD. These results suggest the usefulness of radial AI as a risk marker for future onset of CHD in middle-aged men with mild to moderate hypercholesterolemia.

DOI： 10.5551/jat.2949

Scopus

researchmap

掲載種別：研究論文（学術雑誌）  

Objective: We performed a 1-year follow-up study to determine the effects of smoking status and insulin resistance on the prevalence of metabolic syndrome. Methods: This study included 2136 workers without metabolic syndrome at baseline who were followed for 1 year. The subjects were divided into four categories of smoking and work history, respectively. Insulin resistance was evaluated using the homeostasis model assessment for insulin resistance (HOMA-R). Results: The prevalence of metabolic syndrome after 1 year was 6.3%. A multiple logistic regression analysis showed that the current smokers category versus the nonsmokers category, a 0.1-point increase in the HOMA-R score, a 1-point increase in the uric acid level, age, and body mass index were significantly correlated with increased odds for metabolic syndrome, yielding odds ratios (95% confidence intervals) of 1.61 (1.09-2.39), 1.14 (1.04-1.25), 1.31 (1.12-1.54), and 1.06 (1.03-1.09), and 1.23 (1.15-1.31), respectively. Conclusions: Current smoking, insulin resistance, uric acid level, and age contributed positively to the prevalence of metabolic syndrome. In contrast, smoking cessation within 1 year and work history did not contribute to metabolic syndrome. © 2009 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.orcp.2009.12.004

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MARY ANN LIEBERT INC  

Background: The Framingham Risk Score (FRS) has frequently been used in the United States to predict the 10-year risk of coronary heart disease (CHD). Components of the metabolic syndrome and several lifestyle factors have also been evaluated to estimate the risk of CHD. Methods: To determine the relationship between the FRS and components of metabolic syndrome as coronary risk indicators, the authors conducted a cross-sectional study of 2,619 Japanese male workers, ranging in age from 40 to 64 years, at a single workplace. Although the estimation by the FRS and metabolic syndrome involved some different factors, significant association of the risk estimated by the 2 methods was observed. Results: When logistic regression analysis was conducted with adjustment for several lifestyle factors, the FRS and serum insulin were found to be significantly associated with the risk of likelihood of metabolic syndrome. The odds ratios and 95% confidence intervals of FRS by per standard deviation increment and serum insulin by increasing 1 IU/mL for the prediction of metabolic syndrome were 2.50 (2.17-2.88) and 1.24 (1.20-1.27), respectively. A preventive effect of abstaining from drinking every day and eating breakfast almost daily against the likelihood of metabolic syndrome was also observed. Conclusions: In conclusion, the FRS and insulin were found to be significantly associated with the risk of likelihood of metabolic syndrome, even after controlling for weight change. © 2009 Mary Ann Liebert, Inc.

DOI： 10.1089/met.2008.0087

Web of Science

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Objective: This study examined the relationship between job stain and radial arterial wave reflection as expressed by the augmentation index (AI), a marker of cardiovascular risk, in middle-aged male workers. Methods: Radial AI was measured using automated applanation tonometry in 808 working men (mean age; 47 ± 5 years) at a company in Kanagawa, Japan in 2007. An elevated AI represents the deterioration of arterial properties and increased cardiovascular risk. Job demand and job control (decision latitude) were evaluated by a self-administered, Brief Job Stress Questionnaire. High job strain was defined as the combination of high job demand and low job control. Results: In the entire study population, the mean ± SD and the median of AI were 74 ± 13% and 75%, respectively. High job strain was seen in 267 subjects. In a multiple logistic regression analysis with adjustment for multiple potential confounders, high job strain showed a significantly increased odds ratio (1.47, 95% CI; 1.04-2.09, P = 0.029) for an elevated AI (≥ 75%). Conclusion: High job strain was significantly associated with an elevated radial AI. The measurement of AI may be useful when incorporated in workplace interventions to reduce the risk of cardiovascular disease, especially at sites where workers tend to perceive high job strain. © 2009 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.ypmed.2009.07.005

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Background: Perceived good health or good self-rated health is considered to be a predictor of longer survival and maintenance of good quality of life, which is a public health goal. Objective: This study assessed trends in the percentage of self-rated poor health among Japanese residents, based on data from the National Comprehensive Survey of the Living Conditions of People on Health and Welfare. Methods: Results of the survey (which is conducted in Japan every 3 years to determine the living conditions of people receiving health and welfare services) were analyzed using multistage and stratified cluster sampling of households. Self-rated health was measured by response to the question, "Recently, would you say that in general your health has been good, fairly good, fair, fairly poor, or poor?" The trend in fairly poor or poor health status during the period from 1989 through 2004 was stratified by sex and age group. Results: The rates of response to the survey were 90.9% (246,892/271,588) in 1995 and 79.8% (220,836/276,682) in 2004. Target subjects were aged ≥20 years in each year of the study. The prevalence of self-reported fairly poor or poor health was lowest in 1995 and then increased every year until 2001, when it appeared to reach a plateau. The prevalence of having fairly poor or poor health among women aged 35 to 44, 45 to 54, 55 to 64, and 65 to 74 years were as follows in 1995: 9.2%, 11.7%, 15.3%, and 19.8%, respectively. In 2004, the rates were 13.3%, 17.2%, 22.1%, and 31.7%, respectively. By comparison, the prevalence of self-reported fairly poor or poor health was 8.1%, 9.3%, 13.7%, and 17.9% among men aged 35 to 44, 45 to 54, 55 to 64, and 65 to 74 years, respectively, in 1995. In 2004, these rates were 12.8%, 14.8%, 19.0%, and 27.9%, respectively. Conclusions: In this survey, conducted every 3 years between 1989 and 2004 in Japanese households, older subjects had a greater prevalence of self-reported fairly poor or poor health than did younger subjects. The proportion of respondents who described their health as poor or fairly poor was highest in 1995. Women generally had a greater prevalence of self-reported poor or fairly poor health. © 2009 Excerpta Medica Inc. All rights reserved.

DOI： 10.1016/j.genm.2009.04.001

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

This study aimed to examine whether obesity, including abdominal obesity, is an influential factor for radial arterial wave reflection, as expressed by the augmentation index (AI), in middle-aged Japanese men. Radial arterial pressure waveform was measured using automated applanation tonometry in 828 men (mean age: 47 ± 5 years) during an annual health examination at a company. Radial AI was calculated from the waveforms. AI appeared to be similar between subjects with and without obesity (body mass index (BMI) ≥25 and <25 kg m-2, respectively). However, after adjusting for age, height, heart rate, mean blood pressure, low- and high-density lipoprotein cholesterol, fasting plasma glucose, white blood cell count and other potential confounders, AI was significantly lower in subjects with obesity (71.6%, 95% confidence interval (CI); 70.2-73.0%) than in those without (75.2%, 95% CI; 74.4-76.0%, P<0.001). In a multiple linear regression analysis, BMI was negatively associated with AI (β=-0.20, P<0.001); other factors associated with AI were heart rate (β=-0.56), mean blood pressure (β=0.44), height (β=-0.24), age (β=0.15), current smoking (β=0.09), white blood cell count (β=0.06) and low-density lipoprotein cholesterol (β=0.06). Similar associations were found when waist circumference (WC, an index of abdominal obesity) was substituted for BMI in the analysis (β=-0.12, P<0.001). BMI closely correlated with WC (r=0.87), thus suggesting that approximately 76% (a square of 0.87) of BMI can be explained by WC. In conclusion, although it does not have a major impact, obesity, including abdominal obesity, may be an influential factor for reduced radial AI, independently of well-known confounders, in middle-aged Japanese men.

DOI： 10.1038/hr.2009.33

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Music therapy (MT) has been used in geriatric nursing hospitals, but there has been no extensive research into whether it actually has beneficial effects on elderly patients with cerebrovascular disease (CVD) and dementia. We investigated the effects of MT on the autonomic nervous system and plasma cytokine and catecholamine levels in elderly patients with CVD and dementia, since these are related to aging and chronic geriatric disease. We also investigated the effects of MT on congestive heart failure (CHF) events. Eighty-seven patients with pre-existing CVD were enrolled in the study. We assigned patients into an MT group (n = 55) and non-MT group (n = 32). The MT group received MT at least once per week for 45 minutes over 10 times. Cardiac autonomic activity was assessed by heart rate variability (HRV). We measured plasma cytokine and catecholamine levels in both the MT group and non-MT group. We compared the incidence of CHF events between these two groups. In the MT group, rMSSD, pNN50, and HF were significantly increased by MT, whereas LF/HF was slightly decreased. In the non-MT group, there were no significant changes in any HRV parameters. Among cytokines, plasma interleukin-6 (IL-6) in the MT group was significantly lower than those in the non-MT group. Plasma adrenaline and noradrenaline levels were significantly lower in the MT group than in the non-MT group. CHF events were less frequent in the MT group than in the non-MT group (P < 0.05). These findings suggest that MT enhanced parasympathetic activities and decreased CHF by reducing plasma cytokine and catecholamine levels.

DOI： 10.1536/ihj.50.95

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

Background: High-sensitivity C-reactive protein (hsCRP) has emerged as an independent predictor of coronary heart disease (CHD) in Western countries. However, it is still uncertain regarding whether hsCRP is associated with the risk of CHD in Japan. Methods: The serum hsCRP levels were measured in 687 middle-aged Japanese male workers (age range; 40-59 years) during an annual health examination at a company in Kanagawa, Japan, in 2005. All participants were free from any cardiovascular diseases and any medications for hypertension, hyperlipidemia, or diabetes. The Framingham Risk Score (FRS) was calculated as an individual's risk level of future development of CHD. Associations between hsCRP and the FRS were then evaluated. Results: The distribution of hsCRP was skewed to the left with a median value (interquartile range) of 0.3 (0.2, 0.6) mg/L. Log-transformed hsCRP significantly correlated with all components of the FRS except for age. The FRS gradually and significantly increased (p = 0.001 for trend) with an increase in the quartiles of hsCRP after adjusting for multiple potential confounders such as triglycerides, the body mass index, alcohol intake, and a family history of cardiovascular disease. For the highest quartile of hsCRP, crude and above-listed confounders-adjusted odds ratios of the high-risk for CHD (FRS ≥ 6 point) compared to the lowest quartile were 6.97 (95% CI: 3.20-15.17, p < 0.001) and 3.85 (95% CI: 1.69-8.77, p = 0.001), respectively. Conclusions: These results suggest that hsCRP is associated with the risk of CHD, as estimated by the FRS, in middle-aged Japanese men. © 2007 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.ijcard.2007.07.099

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The Rho/Rho-kinase signaling pathway is known to be involved in the pathogenesis of coronary artery spasm. Previous studies reported the efficacy of the Rho-kinase inhibitor, fasudil, in the prevention and relief of coronary spasm. The usefulness of fasudil in combination with conventional vasodilating agents, however, has not been fully examined in patients with vasospastic angina. METHODS AND RESULTS: A total of 26 patients (mean age, 61±11 years) with documented vasospasm in the left anterior descending coronary artery were examined by the acetylcholine stress test. Coronary diameter at the spasm site was measured at baseline and after the administration of vasodilator agents in the following order: intracoronary nitroglycerin (NTG) (300 μg), intravenous fasudil (30 mg, n=15, fasudil group) or saline (n=11, saline group), and again NTG during coronary angiography. The increase in diameter observed following the first NTG administration was found to be similar in the fasudil and saline groups (38.3±23.5% and 42.3±17.1%, respectively). The additional change in diameter on fasudil treatment (16.9±11.2% increase over the diameter after the first NTG administration) was significantly larger than that with saline (-2.8±7.6%, P<0.001). The second administration of NTG did not affect the diameter of the spasm site in either group. CONCLUSIONS: Fasudil further dilated the site of coronary spasm, which had already been treated with NTG in patients with vasospastic angina. These findings support and extend the previous results that showed the feasibility of employing fasudil as a novel therapeutic approach for coronary spasm. © 2008 Lippincott Williams & Wilkins, Inc.

DOI： 10.1097/MCA.0b013e3282f3420c

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本心臓病学会  

冠動脈ベアメタルステント(BMS)留置後の再狭窄に対する血管内超音波検査(IVUS)の有用性を検討した。対象は、2002年4月〜2006年3月までに経皮的冠動脈カテーテルインターベンション(PCI)を行い、150日以降に再度冠動脈造影を行った93例134病変(男性78例、女性15例・平均年齢66歳)であった。内径50%を超える再狭窄を18例(19.4%)、29病変(21.6%)に認めた。再狭窄ありのR群となしのN群との比較で、使用ステント径はR群で有意に小さく(3.3mm vs 3.5mm)、IVUS使用率はR群で有意に低値(44.8% vs 79.0%)であった。多変量ロジスティック回帰解析では、IVUSの使用と3.5mm以上のステント使用が再狭窄回避の独立予測因子であった。使用ステント径3.5mm以上の群では3.0mm以下の群に比し再狭窄率は有意に低く(13.5% vs 37.8%)、3.5mm以上の群ではIVUS使用の有無で差はなかったが、3.0mm以下の群ではIVUS非使用例で有意に再狭窄率が高かった(59.1% vs 17.4%)。

researchmap

担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：社団法人日本産業衛生学会  

DOI： 10.1539/sangyoeisei.50.1

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

The second derivative of the finger photoplethysmogram (SDPTG) has been used as a non-invasive examination for arterial stiffness. The present study sought to elucidate independent determinants of the SDPTG among various cardiovascular risk factors in middle-aged Japanese men. The SDPTG was obtained from the cuticle of the left-hand forefinger in 973 male workers (mean age: 44±6 years) during a medical checkup at a company. The SDPTG indices (b/a and d/a) were calculated from the height of the wave components. Multiple logistic regression analyses revealed that the independent determinants of an increased b/a (highest quartile of the b/a) were age (odds ratio [OR]: 1.12 per 1-year increase, 95% confidence interval [Cl]: 1.09-1.15), hypertension (OR: 1.65, 95% Cl: 1.03-2.65), dyslipidemia (OR: 1.51, 95% Cl: 1.09-2.09), impaired fasting glucose/diabetes mellitus (OR: 2.43, 95% Cl: 1.16-5.07), and a lack of regular exercise (OR: 2.00, 95% Cl: 1.29-3.08). Similarly, independent determinants of a decreased d/a (lowest quartile of the d/a) were age (OR: 1.11 per 1-year increase, 95% Cl: 1.08-1.14), hypertension (OR: 3.44, 95% Cl, 2.20-5.38), and alcohol intake 6 or 7 days per week (OR: 2.70, 95% Cl: 1.80-4.06). No independent association was observed between the SDPTG indices and blood leukocyte count or serum C-reactive protein levels. In conclusion, the SDPTG indices reflect arterial properties affected by several cardiovascular risk factors in middle-aged Japanese men. The association between inflammation and the SDPTG should be evaluated in further studies.

DOI： 10.1291/hypres.30.1211

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

The aim of this study was to examine whether serum uric acid (SUA) concentration was related to the metabolic syndrome (MS). A total of 981 Japanese workingmen were studied. MS was diagnosed based on the modified criteria of the International Diabetes Federation. MS was present in 8.0% of the target participants. Logistic regression analysis using a cutoff value of the SUA of 7.0 mg/dL showed that some components of MS and the logarithmic value of the serum C-reactive protein were associated with a significant odds ratio for predicting elevated SUA. The odds ratios and 95% confidence intervals (CIs) of a high logarithmic value of the serum C-reactive protein, large waist girth, elevated blood pressure, and dyslipidemia for elevated SUA were 1.76 (CI, 1.21-2.55), 1.72 (CI, 1.21-2.45), 1.42 (CI, 1.01-2.00), and 1.87 (CI, 1.30-2.69), respectively. Most of the components of MS were significant determinants of SUA.

DOI： 10.1111/j.1559-4564.2007.06596.x

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

A 52-year-old man with Down's syndrome was implanted with a DDDR pacemaker for advanced atrioventricular block. He was admitted with development of skin eczema and partial exposure of the generator 1 year after reimplantation. There was no evidence of infection on laboratory data. A skin patch test was positive for the metal of the generator (purity 99.9% titanium) after 72 hours. These findings indicated pacemaker contact dermatitis. After the patient was reimplanted with a pacemaker wrapped with a polytetrafluoroethylene sheet, there has been no recurrence of the contact dermatitis during a follow-up period of 3 years. © 2006, The Authors.

DOI： 10.1111/j.1540-8159.2006.00535.x

Web of Science

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

狭心症またはその疑いで冠動脈造影を行い,冠動脈に有意な狭窄を認めなかった90例を対象として,58例ではアセチルコリン(ACh)負荷試験施行後ドップラーガイドワイヤーを用いて冠予備能を測定した.32例のACh未負荷群では冠予備のみ測定した.ACh負荷群の冠予備能は冠攣縮陰性例と陽性例とで差はなく,測定枝に限らず同様であった.また,ACh負荷群の冠予備能は未負荷群に比べ有意に高値であった.以上より,心外膜冠動脈の攣縮性と微小循環障害の存在とは相関しないと考えられた.ACh負荷群の冠予備能がACh未負荷群より高値であることから,AChにより微小血管レベルでATPによる血流増加反応が増強する可能性がある.この増強反応がAChの効果と判断するには,年齢・性別を一致させた前向き検討,または同一症例での検討が必要と思われた

researchmap

担当区分：最終著者  

The Framingham Risk Score is considered to predict 10-yr. risk of developing coronary heart disease. Other risk factors, such as a family history of coronary heart disease, sedentary lifestyle, and obesity should also be considered when estimating the risk of development of coronary heart disease. The last two factors can be modified by therapeutic lifestyle alterations. This cross-sectional coronary risk assessment of 16,871 Japanese subjects was estimated by the Framingham Risk Score. Sex and age were included in the calculation of the Framingham Risk Score. When multiple regression analysis was conducted controlling for age, regular physical exercise, smoking, and drinking, the body mass index was significantly associated with the Framingham Risk Score. The standardized regression coefficients for body mass index were.271 in men (p<.001) and.211 in women (p<.001), respectively. The significant association of body mass index with coronary heart disease risk, as estimated by the Framingham Risk Score, confirmed prior work. © Perceptual and Motor Skills 2006.

DOI： 10.1093/ietcom/e89-b.1.254

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

Background: Recent studies have suggested that the Rho/Rho-kinase mediated pathway (Rho-kinase pathway) regulates the vasomotion of arteries in pathological conditions. However, it remains unclear regarding whether this pathway regulates the coronary vasomotion of atherosclerotic lesions. Methods and Results: The coronary diameter at the concentric stenotic site, which is considered to reflect the whole circumferential atherosclerosis, in patients with stable angina pectoris (SAP; n=11) and the control site in patients with SAP and chest pain syndrome (CPS; n=9), was measured at baseline and after the intracoronary administration of nitroglycerin (200 μg) and the subsequent intravenous infusion of fasudil (30 mg for 30 min), a Rho-kinase inhibitor, during coronary angiography. The change in the diameter with fasudil at the concentric stenotic site (22.0±10.0%) was significantly higher than that with nitroglycerin (4.7±6.0%, p<0.001) in patients with SAP. Meanwhile, the vasodilatory effect of nitroglycerin and fasudil at the control site was similar in both group of patients (25.5±17.3% and 21.9±14.9% in SAP and 34.4±20.8% and 33.2±23.6% in CPS, respectively). Conclusions: The vasodilatory effect of the subsequent administration of fasudil surpassed that of nitroglycerin at the concentric coronary stenosis in patients with SAP, thus suggesting that the Rho-kinase pathway regulates the coronary vasomotion of atherosclerotic lesions.

DOI： 10.1253/circj.70.402

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

Background: Increased arterial stiffness has been shown to be associated with coronary heart disease (CHD). However, it remains unclear as to whether the second derivative of the finger photoplethysmogram (SDPTG), a non-invasive method for the assessment of arterial stiffness, is useful for the estimation of risk of CHD in the general population. Methods and Results: The SDPTG in 211 subjects (age: 63±15 years, range: 21-91 years, 93 males) was recorded without apparent atherosclerotic disorders from a community. The relationship between the SDPTG indices (b/a and d/a) and coronary risk factors (n=211) or the Framingham risk score (n=158, age: 60±12 years, range: 30-74 years, 63 males) were analyzed. The SDPTG indices significantly correlated with the Framingham risk score in both genders (b/a; rmale=0.43, r female=0.54 and d/a; rmale=-0.38, rfemale=-0. 58), as well as several coronary risk factors. In the receiver operating characteristics curve analyses, the b/a discriminated high-risk subjects for CHD, who were in the highest quintile of the Framingham risk score in each gender, with a sensitivity and specificity of 0.85 and 0.58 in males and 0.83 and 0.72 in females, respectively. Conclusions: These results suggest that the SDPTG is useful for the estimation of risk of CHD in the general population.

DOI： 10.1253/circj.70.304

Scopus

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Middle-aged workingmen (N=984) with no present medical treatment were enrolled to determine whether there is an association between the metabolic syndrome (MetS) and serum levels of C-reactive protein. MetS was defined as follows: waist circumference > or = 85 cm as a necessary criterion; in addition, two or more of the following criteria were required: serum triglycerides > or = 150 mg/dL and/or highdensity lipoprotein cholesterol <40 mg/dL; systolic blood pressure > or = 130 mm Hg and/or diastolic blood pressure > or = 85 mm Hg; fasting blood glucose > or = 110 mg/dL. Three groups were identified by the components of MetS: a reference group of subjects with a waist circumference <85 cm; group A, with a waist circumference > or = 85 cm with no or one additional MetS criterion; and group B, subjects satisfying the criteria for a diagnosis of MetS. Logistic regression analysis revealed that the components of MetS contributed significantly to serum levels of C-reactive protein. The odds ratios were 2.5 (group A) and 4.0 (group B), when 3 mg/L was adopted as the cutoff value of C-reactive protein.

DOI： 10.1111/j.1559-4564.2006.05706.x

Scopus

PubMed

researchmap

開催年月日： 2021年10月

記述言語：日本語  

researchmap

開催年月日： 2020年7月

記述言語：英語  

researchmap

開催年月日： 2019年11月

記述言語：英語  

0

researchmap

開催年月日： 2019年10月

記述言語：日本語  

researchmap

開催年月日： 2019年10月

記述言語：日本語  

researchmap

開催年月日： 2019年10月

記述言語：英語  

researchmap

開催年月日： 2019年6月

記述言語：日本語  

researchmap

開催年月日： 2019年3月

記述言語：英語  

researchmap

開催年月日： 2019年1月

記述言語：日本語  

researchmap

開催年月日： 2018年12月

記述言語：日本語  

researchmap

開催年月日： 2018年9月

記述言語：日本語  

researchmap

開催年月日： 2018年9月

記述言語：日本語  

researchmap

開催年月日： 2018年3月

記述言語：英語  

researchmap

開催年月日： 2017年10月

記述言語：日本語  

researchmap

開催年月日： 2017年10月

記述言語：日本語  

researchmap

開催年月日： 2017年10月

記述言語：日本語  

researchmap

開催年月日： 2017年10月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（指名）  

researchmap

開催年月日： 2017年10月

記述言語：日本語  

researchmap

開催年月日： 2017年9月

記述言語：日本語  

researchmap

開催年月日： 2017年5月

記述言語：日本語  

【背景】医療費に占める割合を傷病分類別にみた場合、循環器系疾患が占める割合は他疾患と比較して最も高い。したがって、循環器系疾患の危険因子が集積した病態であるメタボリックシンドローム(MetS)を予防することにより医療費の適正化も期待できると考えられる。本研究では、労働年齢集団におけるMetSの保有や各因子の集積状況がその後の高額医療費、入院発生へ与える影響について検討した。【方法】某精密機器製造企業で平成22年度の定期健康診断を受診し、同社の健康保険組合に継続加入していた社員14,019人(男性12,065人、平均年齢41.1±7.4歳)を対象とし、計5年間の追跡を行なった。健診結果から対象者を非MetS群とMetS群に分類し、多重ロジスティック回帰分析により高額医療費並びに入院発生リスクの検討を行なった。高額医療費の定義は、5年間の1人当たり合計医療費が600,000円以上、対象集団の上位10%以内、上位5%以内の3通りを設定した。更に、MetSの診断基準に基づき対象者を肥満(腹部肥満)の有無とその他の診断基準項目の個数(0個、1個、2個以上)により層別化して分類し同様のリスク分析を行なった。加えて、集団寄与危険割合に準拠して、危険因子が寄与している過剰医療費の推定を行なった。【結果】非MetS群とMetS群を比較すると、MetS群において5年間の1人当たり合計医療費が600,000円以上となるリスクは有意に上昇し(オッズ比[OR]1.91、95%信頼区間[CI]1.55-2.35)、同様に上位10%以内、上位5%以内となるリスクも有意に上昇した。一方、入院発生リスクは有意な上昇を認めなかった(OR1.20、95%CI0.93-1.56)。また、いずれの定義においても高額医療費発生リスクは肥満の有無に関わらずMetS診断基準項目数の増加とともに上昇したが、そのリスクは肥満がある群でより高かった。入院発生リスクに関しては、肥満がある場合のみ有意な上昇を認めた。総医療費に占める過剰医療費の割合については、高額医療費発生リスクが最大となる「肥満/診断基準項目2個以上」の群(1.2%)よりも、より低リスクの群が占める割合が高かった(非肥満/診断基準1個、1.5%;肥満/診断基準1個、2.5%)。【結語】比較的若年の労働者集団において、MetSの保有は高額医療費発生のリスクを上昇させた。また、MetSの診断基準となる代謝異常の集積は高額医療発生リスクを段階的に上昇させた。一方、過剰医療費割合の分析結果から、医療費の適正化に際しては高リスク群への介入のみならずより低リスクの群に対しても肥満や代謝異常への介入を行なっていくことの重要性が示唆された。(著者抄録)

researchmap

開催年月日： 2017年3月

記述言語：英語  

researchmap

開催年月日： 2017年

記述言語：日本語  

researchmap

開催年月日： 2016年5月

記述言語：日本語  

researchmap

開催年月日： 2016年3月

記述言語：英語  

researchmap

開催年月日： 2015年10月

記述言語：日本語  

researchmap

開催年月日： 2015年10月

記述言語：日本語  

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J04260&link_issn=&doc_id=20151207410020&doc_link_id=%2Fcw1nimed%2F2015%2Fs01104%2F013%2F0221-0221%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2015%2Fs01104%2F013%2F0221-0221%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

開催年月日： 2015年10月

記述言語：日本語  

researchmap

開催年月日： 2015年6月

記述言語：日本語  

researchmap

開催年月日： 2015年5月

記述言語：日本語  

researchmap

開催年月日： 2015年4月

記述言語：日本語  

researchmap

開催年月日： 2015年

researchmap

開催年月日： 2015年

記述言語：日本語  

researchmap

開催年月日： 2014年10月

記述言語：日本語  

researchmap

開催年月日： 2014年5月

記述言語：日本語  

researchmap

開催年月日： 2014年4月

記述言語：日本語  

researchmap

開催年月日： 2013年10月

記述言語：日本語  

researchmap

開催年月日： 2013年9月

記述言語：日本語  

researchmap

開催年月日： 2013年5月

記述言語：日本語  

researchmap

開催年月日： 2013年5月

記述言語：日本語  

researchmap

開催年月日： 2013年5月

記述言語：日本語  

researchmap

開催年月日： 2013年3月

記述言語：英語  

researchmap

開催年月日： 2012年9月

記述言語：日本語  

researchmap

開催年月日： 2012年9月

記述言語：日本語  

researchmap

開催年月日： 2012年5月

記述言語：日本語  

researchmap

開催年月日： 2012年4月

記述言語：日本語  

【目的】高血圧治療ガイドライン2009(JSH2009)において6g/日未満の減塩を目標に掲げているが、実際の一日食塩摂取量はあまり把握されていない。食塩摂取量の評価方法には食事内容調査や尿中Na排泄量測定があり、後者の蓄尿法が最も信頼性が高いとされているが、24時間蓄尿が困難なため外来診療ではほとんど施行されていないのが実状である。そこでより簡便な方法として、半定量ソルトペーパー法による随時尿中食塩濃度から一日食塩摂取量(排泄量)を推定する方法を考案する。【対象と方法】外来通院中高血圧患者92例の来院時尿中食塩濃度をウロペーパー'栄研'ソルト(栄研化学株式会社製)で測定し、結果を2g/L単位で得た。JSH2009に記載されている式より一日尿中食塩排泄量を求め、実測尿中Na濃度およびCl濃度から求めた値と比較した。【結果】ウロペーパーによる尿中食塩濃度(x、g/L)と一日尿中食塩排泄量(y、g/日)の関係は一次式(y=0.48x+5.4、R=0.450、P<0.001)で表された。xから求めた尿中Na濃度(mEq/L)は実測尿中Na濃度(R=0.405、P<0.001)およびCl濃度(R=0.429、P<0.001)とそれぞれ相関し、yと実測尿中Na濃度およびCl濃度から求めた一日尿中食塩排泄量はいずれも良好な相関を求めた(それぞれ、R=0.847、P<0.001、R=0.852、P<0.001)。【考察】簡易的なウロペーパーによる随時尿中食塩濃度から一次式を用いて一日食塩摂取量は推定可能と考えられた。ウロペーパー測定値から求めた尿中食塩排泄量は実測値から求めた値とよく相関した。また、ウロペーパーは塩素イオン濃度を利用した測定原理のためNa濃度よりCl濃度との相関が強かった。随時尿法では過少評価している可能性があるが、外来診療の中で簡便に一日食塩摂取量を推定する方法として使用できると考えられた。ただし、推定に大きな誤差が生じる場合があることから、臨床現場における指導に用いる際にはその限界を認識し、注意深く使用する必要がある。(著者抄録)

researchmap

開催年月日： 2012年4月

記述言語：日本語  

researchmap

開催年月日： 2012年4月

記述言語：日本語  

researchmap

開催年月日： 2012年3月

記述言語：英語  

researchmap

開催年月日： 2012年2月

記述言語：日本語  

researchmap

開催年月日： 2012年1月

記述言語：日本語  

researchmap

開催年月日： 2011年10月

記述言語：日本語  

researchmap

開催年月日： 2011年10月

記述言語：日本語  

researchmap

開催年月日： 2011年6月

記述言語：日本語  

researchmap

開催年月日： 2011年5月

記述言語：日本語  

researchmap

開催年月日： 2011年4月

記述言語：日本語  

researchmap

開催年月日： 2011年4月

記述言語：英語  

researchmap

開催年月日： 2011年4月

記述言語：日本語  

researchmap

開催年月日： 2011年2月

記述言語：日本語  

researchmap

開催年月日： 2011年2月

記述言語：日本語  

researchmap

開催年月日： 2011年1月

記述言語：日本語  

researchmap

開催年月日： 2010年10月

記述言語：日本語  

researchmap

開催年月日： 2010年10月

記述言語：日本語  

researchmap

開催年月日： 2009年10月

記述言語：日本語  

researchmap

開催年月日： 2009年8月

記述言語：日本語  

researchmap

開催年月日： 2009年3月

記述言語：英語  

researchmap

開催年月日： 2009年3月

記述言語：英語  

researchmap

開催年月日： 2008年4月

記述言語：日本語  

researchmap

開催年月日： 2008年3月

記述言語：英語  

researchmap

開催年月日： 2008年3月

記述言語：英語  

researchmap

開催年月日： 2008年3月

記述言語：日本語  

researchmap

開催年月日： 2008年2月

記述言語：日本語  

researchmap

開催年月日： 2007年8月

記述言語：日本語  

researchmap

開催年月日： 2007年4月

記述言語：日本語  

researchmap

開催年月日： 2007年3月

記述言語：英語  

researchmap

開催年月日： 2007年3月

記述言語：英語  

researchmap

開催年月日： 2006年9月

記述言語：日本語  

researchmap

開催年月日： 2006年9月

記述言語：日本語  

researchmap

開催年月日： 2006年9月

記述言語：日本語  

researchmap

開催年月日： 2006年7月

記述言語：日本語  

researchmap

開催年月日： 2005年8月

記述言語：日本語  

researchmap

開催年月日： 2003年9月

記述言語：日本語  

researchmap

開催年月日： 2003年4月

記述言語：日本語  

researchmap

開催年月日： 2003年4月

記述言語：日本語  

researchmap

開催年月日： 2003年3月

記述言語：英語  

researchmap

開催年月日： 2003年1月

記述言語：日本語  

researchmap

開催年月日： 2002年10月

記述言語：日本語  

researchmap

開催年月日： 2002年9月

記述言語：日本語  

researchmap

開催年月日： 2002年8月

記述言語：日本語  

researchmap

開催年月日： 2002年8月

記述言語：日本語  

researchmap

開催年月日： 2002年

researchmap

開催年月日： 2002年

researchmap

開催年月日： 2002年

researchmap

開催年月日： 2002年

researchmap

開催年月日： 2002年

researchmap

開催年月日： 2001年

researchmap

開催年月日： 2001年

researchmap

開催年月日： 2001年

researchmap

開催年月日： 2001年

researchmap

開催年月日： 2001年

researchmap

開催年月日： 2001年

researchmap

開催年月日： 2001年

researchmap

開催年月日： 2001年

researchmap

開催年月日： 2000年

researchmap

開催年月日： 1999年3月

記述言語：日本語  

researchmap

開催年月日： 1998年2月

記述言語：日本語  

researchmap

開催年月日： 1998年2月

記述言語：日本語  

researchmap

開催年月日： 1997年8月

記述言語：日本語  

researchmap