Outcome and characteristics of out-of-hospital cardiac arrest according to location of arrest: A report from a large-scale, population-based study in Osaka, Japan.

OBJECTIVE: To evaluate the outcome and the factors concerned with of out-of-hospital cardiac arrest patients according to the location of the collapse. METHODS: From May 1st, 1998 to April 30th, 2001, 15,211 consecutive out-of-hospital cardiac arrest cases considered for resuscitation were recorded. Of these cases 7540 arrests in subjects aged 18 years or older with cardiac aetiology were analyzed. The outcome and the related-factors, particularly incidence of ventricular fibrillation, were evaluated according to the location of the cardiac arrest. To analyze the factors that affect the incidence of ventricular fibrillation, a logistic regression model was used. RESULTS: About three-quarters of out-of-hospital cardiac arrests occurred at private residences. The outcome and characteristics were significantly different according to the location of the arrest. Arrest patients in public or in the work place had a higher chance of being found in ventricular fibrillation and survival than those at a private residence. The multivariate adjusted odds ratios for ventricular fibrillation in a public or work place were significantly higher than that in private residences, after adjusting for covariates affecting initial rhythm, such as age, sex, witnessed status, bystander cardiopulmonary resuscitation, and response interval. CONCLUSION: Although the majority of out-of-hospital cardiac arrests occur at private residences, arrests in public or in the work place had a higher chance of being found in ventricular fibrillation and survival than those at private residences. In order to establish a system to improve the outcome of out-of-hospital cardiac arrest, a well-considered strategy considering the location of arrest is necessary.

Association between C-reactive protein and insulin resistance in a Japanese population: the Minoh Study.

OBJECTIVE: To investigate the association between C-reactive protein (CRP) and insulin resistance. MATERIALS AND METHODS: This study included 1,624 Japanese participants (652 men and 972 women) aged 40 to 69 years who were non-diabetics or did not have medication for hypertension or dyslipidemia, a history of cardiovascular disease or CRP levels >10 mg/l. Serum CRP level, fasting glucose level, and fasting insulin level were measured, and the degree of insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). Categories of CRP were defined by the following tertiles: <0.25 mg/l, 0.25-0.59 mg/l, and > or = 0.60 mg/l. RESULTS: Elevated CRP levels were associated with increased fasting insulin levels, fasting glucose levels, and HOMA-IR in both men and women. Although the adjustment for body mass index in addition to age, cigarette smoking, and alcohol consumption attenuated the associations between CRP and fasting insulin, fasting glucose, and HOMA-IR, elevated CRP levels were associated with increased insulin levels and HOMA-IR in both sexes. Stratified analyses by CRP level and obesity showed that obesity status was associated with increased fasting insulin levels, fasting glucose levels, and HOMA-IR in both sexes and that fasting insulin levels, fasting glucose levels, and HOMA-IR were higher among obese individuals than among non-obese individuals at the same level of CRP. CONCLUSION: These results suggest a possible role of subclinical inflammation in insulin resistance and glucose intolerance in Japanese, but it only partly explains the link between obesity and impaired glucose homeostasis.

Brachial-ankle pulse wave velocity and metabolic syndrome in a Japanese population: the Minoh study.

To investigate the association between brachial-ankle pulse wave velocity (baPWV) and metabolic syndrome (MS), we examined 374 men and 622 women aged 40 to 69 years who did not have a past history of either coronary heart disease or stroke. We used a modified National Cholesterol Education Program definition of MS that utilizes body mass index instead of waist circumference. Age-adjusted mean values of baPWV were greater when obesity, high systolic and diastolic blood pressures, high triglyceride level, low high-density lipoprotein cholesterol, high fasting glucose level or MS itself were present. baPWV was also associated with fasting insulin levels and homeostasis model assessment of insulin resistance (HOMA-IR) values. Mean values of baPWV (adjusted for age, smoking status, and drinking status) in men with 0, 1, 2, and > or =3 features of MS were 1,409, 1,517, 1,640, and 1,665 cm/s, respectively (p for trend <0.001). The respective adjusted mean baPWV values for women were 1,368, 1,531, 1,547, and 1,661 cm/s (p for trend <0.001). As for insulin resistance, the adjusted mean baPWV values across quartiles of HOMA-IR (lowest to highest) were 1,488, 1,514, 1,566, and 1,624 cm/s (p for trend <0.001) for men. The respective adjusted mean baPWV values for women were 1,395, 1,441, 1,464, and 1,539 cm/s (p for trend <0.001). Our findings indicate that clustered features of MS and insulin resistance are strongly associated with the risk for increased baPWV in Japanese men and women.

Association between fasting glucose and C-reactive protein in a Japanese population: the Minoh study.

To investigate the association between fasting glucose and C-reactive protein (CRP), we examined 1715 Japanese individuals (723 men and 992 women) aged 40-69 years who did not have medication for hypertension, diabetes, or dyslipidemia, a history of cardiovascular disease or CRP levels>10mg/l. There was a statistically significant unadjusted correlation between CRP and each component of the metabolic syndrome, including fasting glucose, fasting insulin, body mass index, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol (negative), and triglycerides in both men and women. With adjustment for age, cigarette smoking, alcohol intake, and other components of the metabolic syndrome, the CRP increments (as back-transformed) compared with the lowest tertile of normal fasting glucose were 0.99, 1.05, 1.21, and 1.34mg/l (P for trend=0.008) with the second lowest and highest tertiles of normal fasting glucose, impaired fasting glucose, and type-2 diabetes, respectively in men. The respective adjusted CRP increments were 1.12, 1.23, 1.33, and 1.93mg/l (P for trend<0.001) in women. In the stratified analyses of CRP levels by sex, obesity status, and fasting glucose category or the number of components of the metabolic syndrome, an increase in CRP levels was greater in women than men with obesity and higher fasting glucose category (gender interaction: P<0.001) or an increased number of components of the metabolic syndrome (gender interaction: P=0.003). These results indicate that CRP levels increase continuously across the spectrum of fasting glucose in both sexes. This association is more pronounced in women.

Metabolic syndrome and risk of isolated ST-T abnormalities and type 2 diabetes in Japanese male office workers.

Using a modified National Cholesterol Education Program (NCEP) definition of the metabolic syndrome (MS) with body mass index instead of waist circumference, we examined the associations of the MS with the risk of developing ST-T abnormalities in 3405 Japanese men aged 35-59 yr who did not have a history of cardiovascular disease or ST-T abnormalities. Of 3405 participants, 3166 men without type 2 diabetes (as diagnosed with the revised criteria of American Diabetes Association) also constituted a non-diabetic cohort. Examinations including electrocardiogram and fasting plasma glucose were repeated annually for 7 subsequent years. The subjects were classified as having ST-T abnormalities or type 2 diabetes when evidence of either of these disorders was found during at least 2 consecutive annual examinations. After adjustment for potential risk factors, the relative risks of ST-T abnormalities were 1.0 (referent), 2.66, 3.07, 4.27, and 8.40 for the presence of 0, 1, 2, 3, and > or =24 components of the MS, respectively (P for trend <0.001). The corresponding results for the risk of type 2 diabetes were 1.0 (referent), 3.49, 7.45, 15.00, and 24.04 (P for trend <0.001). The estimated incident rates for men in the low-WBC count (<7.3 x 10(9) cells/L)/no MS, high-WBC count (> or =7.3 x 10(9) cells/L)/no MS, low-WBC count/yes MS, and high-WBC count/yes MS were 3.4%, 4.6%, 7.4%, and 13.1% for ST-T abnormalities, respectively and were 3.6%, 7.1%, 18.0%, and 27.2% for type 2 diabetes, respectively. The respective multivariate-adjusted relative risks were 1.0 (referent), 1.26, 2.07, and 3.45 for ST-T abnormalities and were 1.0 (referent), 1.75, 5.14, and 6.90 for type 2 diabetes. A modified NCEP MS definition predicts ST-T abnormalities and type 2 diabetes. WBC count adds clinically important information to new-onset ST-T abnormalities and type 2 diabetes.

Cigarette smoking and the risk of the metabolic syndrome in middle-aged Japanese male office workers.

To examine the association between cigarette smoking and the risk of the metabolic syndrome (MS), 3649 Japanese male office workers aged 35-59 yr who did not have a history of cardiovascular disease were enrolled in this study. 2994 men without the MS at entry were followed up over a 7-yr period. A modified National Cholesterol Education Program definition with body mass index instead of waist circumference was used for the MS. With adjustment for age, family history of diabetes, alcohol intake, and regular physical activity, the odds ratios of the MS were 1.0 (referent), 1.30 (95% confidence interval (CI), 1.00-1.68), 1.07 (95% CI, 0.82-1.39), 1.17 (95% CI, 0.88-1.56), and 1.66 (95% CI, 1.24-2.20) for never smokers, ex-smokers, and those who smoked 1-20 cigarettes/d, 21-30 cigarettes/d, and > or =31 cigarettes/d, respectively (P for trend for current smokers only =0.006). As for the risk of developing the MS, the respective multivariate-adjusted hazard ratios of developing the MS were 1.0 (referent), 1.43 (95% CI, 1.14-1.79), 1.14 (95% CI, 0.91-1.44), 1.45 (95% CI, 1.14-1.84), and 1.59 (95% CI, 1.24-2.05) (P for trend for current smokers only =0.001). Among men without the MS at entry, body weight gain over 7 yr, compared with never smokers, was significantly higher in smokers who quit smoking. It is important for the prevention of the MS not only to quit smoking but also to prevent weight gain after smoking cessation.

C-reactive protein concentration is more strongly related to metabolic syndrome in women than in men: the Minoh Study.

BACKGROUND: The gender differences in the association between C-reactive protein (CRP) and features of the metabolic syndrome (MS) need to be elucidated among Japanese. METHODS AND RESULTS: The study population included 715 men and 988 women aged 40-69 years who were not taking anti-hypertensive, lipid-lowering, hypoglycemic, anti-thrombotic, or non-steroidal anti-inflammation medications, and did not have a past history of cardiovascular disease or CRP concentration >10 mg/L. Except for high-density lipoprotein cholesterol, the unadjusted correlation between CRP and each MS component, including body mass index (BMI), systolic and diastolic blood pressures, triglycerides, fasting glucose, fasting insulin, and uric acid, was greater in women than in men. With adjustment for age, smoking status, and drinking status, the differences in CRP concentrations between those with the MS components of BMI, triglycerides, and uric acid and those without were greater in women than in men. Results of stratified analyses by the number of components of the MS of 0, 1, 2, 3, and > or = 4 revealed that an increase in CRP concentrations was greater in women than men with an increased number of components of the MS (gender interaction, p = 0.005). This tendency was observed in non-smokers, but not in current smokers (gender interaction, p = 0.013 and = 0.513, respectively). CONCLUSIONS: CRP concentrations are closely related to the MS-like state in both sexes, but an increase in CRP concentration associated with risk factor-clustering is more pronounced in women, particularly non-smokers.

Relationship between self-assessed masticatory disability and 9-year mortality in a cohort of community-residing elderly people.

OBJECTIVES: To examine the relationship between self-assessed masticatory disability and mortality. DESIGN: Prospective. SETTING: Community based. PARTICIPANTS: Total of 1,405 randomly selected people aged 65 and older living in Settsu, Osaka Prefecture, in October 1992. MEASUREMENTS: Data on health status as indicated by disability scores, history of health management, self-assessed masticatory ability, and psychosocial conditions were collected by means of interviews during home visits at the time of enrollment. Nine-year follow-up was completed for 1,245 (88.6%; 398 deceased and 847 alive). RESULTS: Self-assessed masticatory disability was significantly associated with being 75 and older, having overall disability, not using dental health checks or general health checks, not participating in social activities, not feeling that life is worth living (no ikigai), and finding relationships with people difficult. As for the association between self-assessed masticatory disability and mortality, the estimated survival rate for those with self-assessed masticatory disability was lower than that for those without for each group stratified by sex and age (65-74 and >or=75), and the equality of survival curves according to self-assessed masticatory disability was significant for each group. After controlling for potential predictors of mortality, self-assessed masticatory disability remained as a significant predictor of mortality (adjusted hazard ratio=1.63, 95% confidence interval=1.30-2.03, P<.001). CONCLUSION: These results indicate that self-assessed masticatory disability may be associated with a greater risk of mortality in community-residing elderly people.

Daily life activity and the risk of developing hypertension in middle-aged Japanese men.

BACKGROUND: Although previous studies suggest that physical activity may reduce the risk of hypertension, the role of daily life activity in the development of hypertension remains unclear. METHODS: The study population included 2548 Japanese male office workers aged 35 to 59 years, who were without hypertension (systolic blood pressure [SBP] <140 mm Hg, diastolic blood pressure [DBP] <90 mm Hg, and no medication for hypertension) and had no history of cardiovascular disease. Daily life energy expenditure was estimated by a 1-day activity record during an ordinary weekday at study entry. Blood pressures were measured at periodic annual health examinations over 7 successive years. RESULTS: After controlling for potential predictors of hypertension (age, family history of hypertension, alcohol consumption, cigarette smoking, regular physical exercise at entry, and change in body mass index during the follow-up period), mean SBP and DBP in each follow-up year decreased as daily life energy expenditure increased. With additional adjustment for SBP at entry, the relative risk of hypertension (SBP > or =140 mm Hg and/or DBP > or =90 mm Hg or medication for hypertension) across quartiles of daily life energy expenditure (lowest to highest) were 1.00, 0.84, 0.75, and 0.54 (P<.001 for trend). Analyses by presence or absence of a risk factor demonstrated that the risk of hypertension was inversely related to daily life energy expenditure in men at either low or high risk of hypertension. Daily life energy expenditure was also associated with reduced risk of hypertension for subjects in all 3 categories of normotension: low normal, normal, and high normal. CONCLUSIONS: Increased daily life activity is effective for the prevention of hypertension, and this benefit applies to men at either low or high risk of hypertension.

Age-related change in relationship between white blood cell count and some features of the metabolic syndrome.

To examine age-related change in the strength of the association of white blood cell count (WBC) with features of the metabolic syndrome (MS), body mass index, blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, fasting plasma glucose, and uric acid were assessed as the components of the MS in 5,218 Japanese male office workers aged 23-59 yr. The subjects were stratified by age into three groups of 23-39, 40-49, and 50-59 yr. WBC count showed a positive crude correlation with the components of the MS, except for HDL cholesterol (negative), in all three age groups. With an increase in age, an association between WBC count and each component of the MS declined, and an interaction with age weakened. After controlling for potential confounders, the largest differences of WBC count for each categorized feature of the MS were found among those aged 23-39 yr. Stratified analyses by smoking status and age showed that in both non-smokers and current smokers the adjusted WBC count increased as the number of features of the MS increased in all three age groups. In each category of the number of clustered features of the MS, differences of WBC count compared with the presence of no features of the MS were the largest in those aged 23-39 yr in both non-smokers and current smokers. The adjusted odds ratios of > or =3 features of the MS also increased with an increase in WBC count in all three age groups in both non-smokers and current smokers. The adjusted odds ratios of > or =3 features of the MS across quartiles of WBC count (lowest to highest) were the largest in the youngest age group. Our results indicate that a variety of features of the MS are associated with WBC count and that these tendencies are more pronounced in younger individuals in both non-smokers and current smokers.

Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men.

OBJECTIVE: To investigate the association between serum gamma-glutamyltransferase (GGT) and risk of metabolic syndrome and type 2 diabetes in Japanese male office workers. RESEARCH DESIGN AND METHODS: This study included 2,957 metabolic syndrome-free men and 3,260 nondiabetic men aged 35-59 years who did not have medication for hepatitis, alanine aminotransferase (ALT) levels higher than three times the upper limit of the reference range, or a history of cardiovascular disease at study entry. Subjects were reexamined at periodic annual health examinations over a 7-year period. We used a modified National Cholesterol Education Program definition of metabolic syndrome with BMI instead of waist circumference and the revised criteria of the American Diabetes Association for type 2 diabetes. RESULTS: With adjustment for age, family history of diabetes, BMI, alcohol intake, cigarette smoking, regular physical activity (fasting plasma glucose for the risk of type 2 diabetes), and white blood cell (WBC) count, the risk of metabolic syndrome and type 2 diabetes increased in correlation with the levels of serum GGT, ALT, aspartate aminotransferase (AST), and alkaline phosphatase. Additional adjustment for all of the other liver enzymes attenuated these associations, but serum GGT remained a significant risk factor for the risk of both metabolic syndrome and type 2 diabetes (P for trend <0.001 for both). Top one-fifth versus bottom one-fifth relative risks of metabolic syndrome and type 2 diabetes were 2.23 (95% CI 1.51-3.30) and 2.44 (1.34-4.46), respectively. CONCLUSIONS: These results indicate that serum GGT may be an important predictor for developing metabolic syndrome and type 2 diabetes in middle-aged Japanese men.

[Factors promoting follow-up services after medical examinations by municipal governments].

OBJECTIVE: All Japanese municipal governments have a responsibility to conduct a medical examination for their residents aged 40 or more under the Health Services for the Elderly Act since 1984. According to the results of the medical examination, municipal governments should give appropriate follow up services to all users. The objective of this study was to find the factors promoting follow up services after medical examinations conducted by municipal governments. SUBJECTS AND METHODS: Mailed questionnaire surveys on follow up services after medical examination were sent out to all 3,255 municipal governments in Japan. The 2,447 municipal governments that answered all items on the questionnaire were enrolled in this study. Follow-up services by municipal government for persons with abnormal findings at medical examinations included "Suggestion to have a more detailed examination", "Confirmation of having had a detailed examination", "Individual health consultation", and "Home visit for medical guidance". These follow-up services were analysed in terms of the number of public health nurses per population and whether a continuous data set was maintained for medical examinations. RESULTS: Follow-up services were conducted more frequently in municipalities that maintained continuous data sets of medical examination than those that did not. They were also carried out more frequently in municipalities with higher numbers of health visitors per population than in those with lower numbers. The percentage of municipal governments that maintained continuous data of medical examinations was higher among those that conducted group medical examinations than those that conducted individual medical examinations at local medical facilities. CONCLUSION: Follow-up services after medical examinations by municipal governments showed a significant relationship with maintenance of a continuous data set of medical examinations and the number of public health nurses.

Components of the metabolic syndrome as predictors of cardiovascular disease and type 2 diabetes in middle-aged Japanese men.

To determine whether the clustered features of the metabolic syndrome precede the 7 year incidence of cardiovascular disease (CVD) and type 2 diabetes, we examined 6182 Japanese male office workers aged 35-59 years without any history of CVD. The 5588 subjects without type 2 diabetes also constituted the nondiabetic cohort, and were re-examined over seven successive years. Components of the metabolic syndrome included glycemic disorder (type 2 diabetes for the risk of CVD and impaired fasting glucose for the risk of type 2 diabetes), systemic obesity, hypertension, dyslipidemia, proteinuria, and elevated white blood cell (WBC) count. After controlling for age, family history of diabetes, alcohol intake, and cigarette smoking, the multivariate-adjusted relative risk of incidence of CVD compared with absence of components was 3.18, 3.48, 12.55, and 14.15 (P for trend <0.001), for the presence of 1,2,3, and > or =4 components, respectively. The corresponding relative risks of incidence of type 2 diabetes were 1.92, 4.36, 6.44, and 15.08 (P for trend <0.001). In both non-smokers and current smokers, the multivariate-adjusted relative risks of incidence of CVD and type 2 diabetes increased as the number of components increased (P for trend <0.001 for all). Our findings indicate that clustered features of the metabolic syndrome are closely associated with development of CVD and type 2 diabetes in middle-aged Japanese.

Self-reported hearing difficulty and hearing impairment in Japanese people living in a community.

Nine hundred and eighteen people aged 40 years and over were examined to assess the relationship between self-reported hearing difficulty and hearing impairment at 1 kHz and 4kHz during annual health check-ups. After adjustment for potential confounding factors of self-reported hearing difficulty such as age, sex, noise exposure, ear disease and tinnitus. the odds ratios for self-reported hearing difficulty at 1 kHz compared with a hearing threshold of 30 dB were 1.74. 3.37 and 4.97 for hearing thresholds of 40 dB, 50 dB, and over 50 dB, respectively (p-value for trend = 0.003). At 4 kHz, the respective odds ratios for self-reported hearing difficulty were 1.53, 2.59 and 1.83 (p-value for trend = 0.012). These results suggest that self-reported hearing difficulty is closely associated with the severity of hearing impairment at 1 kHz and 4 kHz in a community-residing population and that people with hearing impairment at 1 kHz would be more sensitive to their hearing difficulty than those with hearing impairment at 4 kHz.

Clustering of components of the metabolic syndrome and risk for development of type 2 diabetes in Japanese male office workers.

To investigate the effects of the clustering of components of the metabolic syndrome (MS) on development of diabetes, we examined 3298 Japanese male office workers aged 35-59 years who did not have type 2 diabetes (a fasting plasma glucose level of > or =7.0 mmol/l or receipt of hypoglycemic medication) or a history of cardiovascular disease. Fasting plasma glucose levels were measured at periodic annual health examinations from May 1994 through May 2001. After adjustment for potential risk factors for diabetes, the multivariate-adjusted relative risk of type 2 diabetes compared with the subjects without components of the MS was 1.58 (95% CI: 1.08-2.32), 2.48 (95% CI: 1.69-3.63), 3.10 (95% CI: 2.05-4.68), and 5.22 (95% CI: 3.49-7.83) (P-value for trend <0.001) for those with 1, 2, 3, and > or =4 components, respectively. Even after the subjects were stratified according to fasting plasma glucose level, the clustering of components of the MS was associated with an increased risk of type 2 diabetes for subjects in all three categories of low-normal fasting glucose (a fasting plasma glucose level of <5.1 mmol/l), high-normal fasting glucose (a fasting plasma glucose level of 5.0-6.0 mmol/l), and impaired fasting glucose (a fasting plasma glucose level of 6.1-6.9 mmol/l). These results indicate that clustering of components of the MS associated with diabetes precedes an increase in the risk of type 2 diabetes in Japanese men.

[Relationship between utilization of health notebooks and the elderly population rate among Japanese municipal governments].

OBJECTIVE: Health conditions are changing rapidly in aging societies and an essential health service by municipal governments is to promote the utilization of health notebooks in support of the health of individuals. The objective of this study was to clarify the relationship between utilization of health notebooks and rates for elderly among Japanese municipal governments. SUBJECTS AND METHODS: Questionnaires on the utilization of health notebooks were mailed to all 3,255 municipal governments in Japan. The 2,445 that filled in all items on the questionnaire were enrolled in this study. Questions concerned opportunities for utilizing health notebooks when residents received health education/guidance, health examinations, home visits, or welfare service. If they answered "Frequent use" for these opportunities, one point was given. Furthermore, if they answered that they filled in the results of residents' health examination into health notebooks, one point was given. If a municipal government got 4 points or more, this municipality was classified as "health notebooks frequently used". RESULTS: The percentage of municipalities defined as "health notebooks frequently used" was higher among municipal governments with a high rate of elderly residents than with a lower rate. The odds ratio for being classified as "health notebooks frequently used" was higher among municipal government with high rates for the elderly and public health nurses per elderly person than with low rates. CONCLUSION: With increase in the percentage of elderly residents, municipal governments need to promote their health services in support of residents' health. To improve the utilization of health notebooks, municipalities should increase the number of public health nurses.

Multiple risk factor clustering and risk of hypertension in Japanese male office workers.

Major risk factors associated with hypertension (a family history of hypertension, obesity, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and increased white blood cell counts) were assessed in 5275 Japanese male office workers aged 23-59 years. After controlling for potential risk factors of hypertension, the odds ratio of hypertension compared with the absence of risk factors was 1.91, 2.65, 3.88, 6.54, and 8.18 for the presence of 1, 2, 3, 4, and > or = 5 risk factors, respectively (P for trend < 0.001). Systolic and diastolic blood pressure levels also increased in a dose-dependent manner as the number of risk factors increased. Among men not taking antihypertensive medication, the adjusted mean differences in systolic and diastolic blood pressures (mmHg) were 11.2 and 9.2 between men with the presence of > or = 5 risk factors and men without risk factors, respectively. These results indicate that the accumulation of risk factors is highly associated with the increased risk of hypertension in Japanese men.

Clustered features of the metabolic syndrome and the risk for increased aortic pulse wave velocity in middle-aged Japanese men.

The association between different features of the metabolic syndrome (MS) (obesity, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol level, hypertriglyceridemia, high fasting plasma glucose level, and hyperuricemia) and the risk for increased aortic pulse wave velocity (PWV) of > or = 8.0 m/sec was examined in 2431 Japanese men aged 35 to 54 years who were not taking antihypertensive medication. After controlling for age, cigarette smoking, and alcohol intake, the odds ratios for increased aortic PWV in subjects with 1, 2, 3, and > or = 4 features of the MS, compared with those without features of the MS, were 1.35 (95% CI, 0.86 to 2.11), 1.90 (95% CI, 1.18 to 3.06), 1.57 (95% CI, 0.89 to 2.76), and 2.38 (95% CI, 1.26 to 4.49), respectively (p for trend = 0.003). A 9-year longitudinal study was also performed to prospectively examine the association between clustered features of the MS and the development of increased aortic PWV in 2073 men without aortic stiffness with a PWV < 8.0 m/sec and without antihypertensive medication during the follow-up period. The multivariate-adjusted hazard ratios for the incidence of increased aortic PWV in subjects with 1, 2, 3, and > or = 4 features of the MS, compared with those without features of the MS, were 1.39 (95% CI, 1.10 to 1.77), 1.46 (95% CI, 1.1 1 to 1.92), 1.75 (95% CI, 1.27 to 2.40), and 2.22 (95% CI, 1.52 to 3.25), respectively (p for trend < 0.001). These results suggest that clustered features of the MS are closely associated with the risk for increased aortic PWV in middle-aged Japanese men.

Clustering of cardiovascular risk factors and risk of development of hypertension in Japanese male office workers.

BACKGROUND: Obesity, hypercholesterolaemia, low high-density lipoprotein cholesterol levels, hypertriglyceridaemia, high fasting plasma glucose levels, hyperuricaemia and increased white blood cell count levels are all positively associated with the risk of hypertension, but the effect of the clustering of these risk factors on the risk for development of hypertension remains unclear. DESIGN: Longitudinal study at a work site in Osaka, Japan. METHODS: We examined 3784 Japanese male office workers aged 30 to 59 years who were hypertension-free [systolic blood pressure (SBP) < 140 mmHg, diastolic blood pressure (DBP) < 90 mmHg, no medication for hypertension, and no past history of hypertension]. Blood pressures were measured at annual health examinations from May 1996 to May 2001. RESULTS: After controlling for potential predictors of hypertension, the relative risk of hypertension (SBP>/=140 mmHg, DBP>/=90 mmHg, or both or prescription of antihypertensive medication) compared with the presence of no risk factors was 1.41 (95% CI, 1.21 to 1.64), 1.64 (95% CI, 1.38 to 1.96), 1.93 (95% CI, 1.56 to 2.39), 2.01 (95% CI, 1.51 to 2.68) and 3.34 (95% CI, 2.07 to 5.38) (P value for trend < 0.001) for respective risk factors of 1, 2, 3, 4 and >/=5. Even after the subjects were stratified according to blood pressure, the clustering of risk factors was associated with an increased risk of hypertension for subjects in all three categories of normotension: low-normal, normal, and high-normal. CONCLUSIONS: Clustering of cardiovascular risk factors associated with hypertension precedes an increase in the risk of hypertension in Japanese men.