Regional differences in hypertensive cardiovascular remodeling between fishing and farming communities in Japan

Carotid Ultrasound Screening Programs in Rural Communities: A Systematic Review

Carotid atherosclerosis assessments inform about stroke and cardiovascular risk. It is known that stroke and cardiovascular disease (CVD) prevalence is higher in rural communities than in urban communities. We aimed to conduct a systematic review of rural carotid ultrasound screening programs to define carotid atherosclerosis using traditional and emerging imaging biomarkers, prevalence, and risk factors. We searched Ovid/MEDLINE, Ovid/EMBASE, SCOPUS and CINAHL from inception to 3 April 2020 for rural population studies that utilized carotid ultrasound screening for adults ≥40 years of age and free of known cerebrovascular disease. Studies were included if participants received a bilateral ultrasound scanning of the carotid arteries and reported at least one marker of carotid atherosclerosis pathology. A random effect meta-analyses calculated the estimated prevalence of carotid plaque. In total, 22/3461 articles that met all of the inclusion criteria were included. Studies reported increased intima media thickness (IMT), carotid plaque presence and carotid artery stenosis. There were no studies reporting on novel imaging markers, such as carotid stiffness, carotid plaque morphology or neovascularization. The overall random effect pooled prevalence of carotid plaque was 34.1% (95% CI, 33.6–35.0); the prevalence of increased IMT was 11.2–41.5%, and the prevalence of carotid artery stenosis was 0.4–16.0%. There is an absence of data necessary to understand the carotid atherosclerosis prevalence across global rural populations. Represented studies have focused on East Asian countries where a high burden of rural carotid artery disease has been reported. There is no rural evidence to guide the use of novel ultrasound carotid biomarkers such as stiffness or neovascularization.

Intake of fish and long-chain n-3 polyunsaturated fatty acids and risk of diseases in a Japanese population: a narrative review

Since the 1970s, the potential benefit of fish intake in terms of noncommunicable diseases has been one of the most important themes in disease prevention. Epidemiological studies have revealed the extent to which fish consumption affects the incidence of and mortality from diseases. Meta-analyses summarized the effect of fish and long-chain n-3 polyunsaturated fatty acid intake on noncommunicable diseases, especially cardiovascular diseases in Western countries. However, few reviews have spotlighted the effect of fish intake in East-Asian countries that have high population levels of fish intake such as Japan. We narratively reviewed the epidemiological studies concerned with the associations of fish and long-chain n-3 polyunsaturated fatty acid intake with risk of noncommunicable diseases, mainly of cardiovascular disease, among Japanese, whose fish intake has been twice or more than that of most Westerners. Overall, fish or long-chain n-3 polyunsaturated fatty acid intake may be beneficial for prevention of noncommunicable diseases, especially coronary heart disease and heart failure in Japanese as well as in Westerners. However, the beneficial effects of their intakes seemed to be nonlinear and varied according to disease severity and culture. Studies on other noncommunicable disease were also narratively reviewed.

Ambulatory blood pressure variability increases over a 19-year follow-up in a clinic on a solitary island

OBJECTIVE

This study investigated the changes of ambulatory blood pressure (ABP) profiles on the same participants over a 19-year follow-up.

PARTICIPANTS AND METHODS

This is a longitudinal study. We conducted 24-h ABP monitoring at baseline in November 1997 and at follow-up in November 2016 for the same participants who were outpatients in a solitary island clinic. To estimate ambulatory blood pressure variability (ABPV), SD, coefficient of variation, and average real variability of ABP were calculated. ABP levels and ABPV at baseline and follow-up were compared using paired t-test.

RESULTS

A total of 35 participants were recruited at follow-up (79.3±6.7 years at follow-up). Mean systolic blood pressure levels in 24-h, daytime, and night-time did not change significantly. However, ABPV of systolic/diastolic blood pressure in 24-h and daytime increased at follow-up compared with baseline (P<0.01 in all variables: SD, coefficient of variation, and average real variability), whereas ABPV in night-time did not change significantly.

CONCLUSION

Our observations suggested that 24-h and daytime ABPV increase with aging in community-dwelling elderly people.

An 18-Year Follow-up Survey of Dioxin Levels in Human Milk in Japan

Background

Globally, few published studies have tracked the temporal trend of dioxin levels in the human body since 2000. This study describes the annual trend of dioxin levels in human breast milk in Japanese mothers from 1998 through 2015.

Methods

An observational study was conducted from 1998 through 2015. Participants were 1,194 healthy mothers following their first delivery who were recruited annually in Japan. Breast milk samples obtained from participants were analyzed using gas chromatography and mass spectrometry for dioxins, including polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and coplanar polychlorinated biphenyls (PCBs).

Results

Mean age was 29.5 years, and 53% of participants were 20–25 years old. A declining trend in total dioxin levels was found, from a peak of 20.8 pg toxic equivalence (TEQ)/g fat in 1998 to 7.2 pg TEQ/g fat in 2014. Data from the last 5 years of the study indicated a plateau at minimal levels. In contrast, an increasing trend was found in the mean age of participants during the last 5 years. Although significantly higher dioxin levels were observed in samples from older participants, an upward trend in dioxin levels was not observed, indicating that dietary and environmental exposure to dioxins had greatly diminished in recent years.

Conclusions

Dioxin levels in human breast milk may be approaching a minimum in recent years in Japan. The findings may contribute to global reference levels for environmental pollution of dioxins, which remains a problem for many developing countries.

Impact of omega-3 polyunsaturated fatty acids on vascular function and blood pressure: Relevance for cardiovascular outcomes

AIMS

To overview the effects of omega-3 polyunsaturated fatty acids (PUFA) on blood vessels and blood pressure (BP) and their relevance for cardiovascular prevention.

DATA SYNTHESIS

The importance of omega-3 PUFA for the cardiovascular system has come under the spotlight during the last decades. These fatty acids are present in variable amounts in cell membranes of mammal species, and their content affects a variety of cellular functions. Evidence obtained in animal and human studies suggests that omega-3 PUFA affect many steps of the atherosclerotic process. In blood vessels, omega-3 PUFA improve endothelial function; promote vasodilatation through relaxation of smooth muscle cells; exert antioxidant, anti-inflammatory, and antithrombotic actions; delay development of plaques and increase their stability; and decrease wall stiffening. Omega-3 PUFA might affect BP, and studies conducted with ambulatory monitoring suggest that supplementation with these fatty acids decreases the average 24-h BP levels. This effect on BP is related to the pretreatment membrane content of omega-3 PUFA, and this might explain some inconsistencies among intervention trials. Meta-analyses indicate that omega-3 PUFA have a mild but significant BP lowering effect. While encouraging results were initially obtained with the use of omega-3 PUFA supplements in secondary prevention trials, meta-analyses have not confirmed the ability of these fatty acids to decrease the risk of coronary heart and cerebrovascular disease.

CONCLUSIONS

Omega-3 PUFA are associated with significant improvement in vascular function and lowering of BP. However, the evidence currently supporting the role of these fatty acids in cardiovascular prevention is weak and needs further investigation.

Differences in genotype frequencies of salt-sensitive genes between fishing and nonfishing communities in Japan

PURPOSE

To identify the differences in genotype frequencies of salt-sensitive genes between residents of fishing communities (FCs) and nonfishing communities (NFCs).

METHODS

The subjects included 18,156 individuals (8,043 males [44%] and 10,113 females [56%]; average age: 57.2±16.1 years) from the general population who were registered with large-scale genome banks and resided in 30 prefectures and 78 different regions in Japan. The measurement items were age, sex, blood pressure, presence or absence of hypertension, body mass index, alcohol consumption, and smoking habit. Furthermore, to analyze the genotype frequencies of salt-sensitive genes, α-adducin 1 (ADD1), angiotensinogen (AGT), angiotensin II receptor type 1 (AT1), and guanine nucleotide-binding protein β peptide 3 (GNB3) were measured. According to the 2004 government classification of municipalities (cities, towns, and villages), communities existing in areas bordering an ocean and with an ocean port were defined as FCs (28 areas). The others were defined as NFCs (50 areas). A logistic regression model was used for comparison of genotype frequencies between subjects residing in FCs and NFCs.

RESULTS

Of the included subjects, 4,916 (27.0%) and 13,240 (73.0%) resided in FCs and NFCs, respectively. In FCs, the mean age was 59.4±16.7 years and men accounted for 41.0% of the cohort (n=2,015). In NFCs, the mean age was 56.4±15.8 years and men accounted for 45.5% of the cohort (n=6,028). The adjusted odds ratios of the AA and AG genotypes compared with the GG genotype for AGT were 0.80 (95% confidence interval [CI]: 0.68-0.95) and 0.76 (95% CI: 0.64-0.91), respectively. The adjusted odds ratio of the CC genotype compared with AA for AT1 was 0.63 (95% CI: 0.40-0.93).

CONCLUSION

The incidence of the salt-sensitive genotypes AGT and AT1 in residents of FCs were significantly lower than in NFCs.

Adipose tissue α-linolenic acid is inversely associated with insulin resistance in adults

BACKGROUND

There is emerging evidence of the beneficial effects of n-3 (ω-3) fatty acids (FAs) on cardiometabolic risk factors. Nevertheless, not much is known about the association between adipose tissue α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) and insulin resistance.

OBJECTIVE

We determined the association between adipose tissue n-3 FAs (total n-3 FAs, ALA, and EPA plus DHA) and insulin resistance in healthy adults.

DESIGN

In this cross-sectional study, multivariable analyses were used to assess the association between adipose tissue FAs (ALA, EPA plus DHA, and total n-3 FAs) and the homeostasis model assessment of insulin resistance (HOMA-IR) in a subset of adult participants (n= 716; mean age: 58 y) from the Adventist Health Study-2 (AHS-2) cohort.

RESULTS

Compared with the lowest tertile, the third tertile (β = -0.13; 95% CI: -0.24, -0.01) of adipose tissue ALA was inversely associated with the HOMA-IR. When stratified by waist circumference, ALA continued to be inversely associated [third tertile: β = -0.17 (95% CI: -0.31, -0.02)] with the HOMA-IR in subjects with a waist circumference ≤88 cm in women or ≤102 cm in men but not in those with a larger waist circumference. No significant association was noted between adipose tissue EPA plus DHA and HOMA-IR.

CONCLUSIONS

Higher adipose tissue ALA was inversely associated with insulin resistance in this cohort of healthy adult men and women. This finding appears to be more pronounced in individuals with a normal waist circumference.

Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients

OBJECTIVES

This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients.

METHODS

We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points).

RESULTS

CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima-media thickness (IMT)], hazard ratio 2.5-2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction.

CONCLUSION

Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients.

Circulating des-acyl ghrelin improves cardiovascular risk prediction in older hypertensive patients

BACKGROUND

We aimed to assess the predictive value of circulating levels of des-acyl ghrelin, an abundant form of ghrelin in humans, for the risk of cardiovascular disease (CVD) in older hypertensive patients. We simultaneously evaluated other biomarkers, such as high-molecular-weight (HMW) adiponectin, high-sensitivity C-reactive protein (hs-CRP), and plasminogen activator inhibitor 1 (PAI-1), for their usefulness in risk prediction.

METHODS

We enrolled 590 older hypertensive patients (mean age = 72.9 years; 41.0% men). The incidences of CVD, including coronary artery disease, stroke, congestive heart failure, and sudden death, were prospectively ascertained.

RESULTS

During an average duration of 2.8 (SD = 0.7) years (1,653 person-years), there were 42 CVD events. Patients with CVD events had lower levels of des-acyl ghrelin at baseline than those without CVD events (median = 78.2 vs. 114.7 fmol/ml; P < 0.001). No difference was found among other biomarkers between the patients with CVD events and those without such events. The Cox proportional hazards model adjusted by covariables revealed that the hazard ratio for CVD events in patients with a 1-SD decrease of log des-acyl ghrelin was 1.8 (95% confidence interval = 1.3-2.4). Incorporation of des-acyl ghrelin in the risk model (including age, current smoking, 24-hour systolic blood pressure, preexisting CVD, and carotid intima-media thickness) improved the C statistics (from 0.683 to 0.721; P = 0.22) and resulted in a net reclassification improvement of 20.5% (P = 0.02). In contrast, HMW adiponectin, hs-CRP, and PAI-1 provided no improvement in risk prediction.

CONCLUSIONS

Des-acyl ghrelin improved the prediction of CVD events in older hypertensive patients.

Both chronic kidney disease and nocturnal blood pressure associate with strokes in the elderly

BACKGROUND

Among elderly hypertensive patients, we aimed to assess the association of nocturnal blood pressure (BP) pattern on stroke; interaction of dipping pattern with kidney disease was explored.

METHODS

We retrospectively analyzed the records of 1,276 elderly (≥60 years) hypertensive Japanese patients (mean 74 years; 40% were men) who had measurements of estimated glomerular filtration rate and ambulatory BP.

RESULTS

Stroke events occurred in 73 people over an average of 3.2 years (4,026 person-years). Chronic kidney disease (CKD) at baseline (n = 634, 50%) was more prevalent in people with strokes (71%) than those without strokes (48%; p < 0.01). Both CKD and nocturnal systolic BP (SBP) increase (10 mm Hg) were independently associated with increased risk for stroke [hazard ratio (HR), 1.9; 95% confidence interval (CI), 1.1-3.1 for CKD and HR 1.2; 1.1-1.4 for SBP]. After adjustment for office SBP, a 10-mm Hg increase in nocturnal SBP was similarly associated with strokes in patients with CKD (HR 1.2; 95% CI 1.0-1.3) and those without CKD (HR 1.2; 95% CI 0.97-1.5). Although reverse dipping (nocturnal SBP ≥ daytime SBP) was associated with stroke only in patients with CKD (HR 2.1; 95% CI 1.1-4.1) and not those without CKD (HR 1.1; 95% CI 0.3-3.8), the interaction effect was not significant (p = 0.30).

CONCLUSION

In elderly hypertensive patients, both high nocturnal SBP and CKD are independent risk factors for stroke.

Fetal growth, omega-3 (n-3) fatty acids, and progression of subclinical atherosclerosis: preventing fetal origins of disease? The Cardiovascular Risk in Young Finns Study

BACKGROUND

Impaired fetal growth is independently associated with an increased risk of cardiovascular events in adulthood. Prevention strategies that can be implemented during adulthood have not been identified.

OBJECTIVE

The objective was to determine whether habitual omega-3 (n-3) fatty acid intake is associated with the rate of increase of carotid intima-media thickness during adulthood in individuals with impaired fetal growth.

DESIGN

This was a population-based, prospective cohort study of 1573 adults in Finland. Carotid intima-media thickness was assessed in 2001 (at ages 24-39 y) and in 2007. Participants were categorized as having had impaired fetal growth (term birth with birth weight <10th percentile for sex or preterm birth with birth weight <25th percentile for gestational age and sex; n = 193) or normal fetal growth (all other participants; n = 1380). Omega-3 fatty acid intake was assessed by using a food-frequency questionnaire and on the basis of serum fatty acid concentrations.

RESULTS

In multivariable models, the 6-y progression of carotid intima-media thickness was inversely associated with dietary omega-3 fatty acids in those with impaired fetal growth (P = 0.04). Similarly, serum omega-3 fatty acid concentrations were inversely associated with the 6-y progression of carotid intima-media thickness in those with impaired fetal growth (P = 0.04) but were not noted in those with normal fetal growth (P = 0.94 and P = 0.26, respectively).

CONCLUSION

Dietary intake of omega-3 fatty acids is associated with a slower rate of increase in carotid intima-media thickness in those with impaired fetal growth.

Independent association of cognitive dysfunction with cardiac hypertrophy irrespective of 24-h or sleep blood pressure in older hypertensives

BACKGROUND

Our aim was to assess whether cardiac hypertrophy is associated with cognitive function independently of office, 24-h, or sleep blood pressure (BP) levels in older hypertensive patients treated with antihypertensive medications.

METHODS

In this cross-sectional study, we recruited 443 hypertensive patients aged over 60 years (mean age: 73.0 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. They underwent measurements of 24-h BP monitoring, echocardiographic left ventricular mass index (LVMI), and cognitive function (mini-mental state examination, MMSE).

RESULTS

MMSE score was inversely associated with office, 24-h, awake, and sleep systolic BP (SBP) (each, P < 0.05). There was a close association between MMSE score and LVMI (ρ = -0.32; P < 0.001). Using multiple logistic regression analysis including numerous covariates (i.e., age, sex, obesity, current smoking, educational level, duration of antihypertensive medications, renal dysfunction, statin use, and previous history of cardiovascular disease), the odds ratio (OR) for the presence of cognitive dysfunction, defined as the lowest quartile of MMSE score (median MMSE score: 23 points; n = 115), was estimated; the presence of cardiac hypertrophy (LVMI ≥125 kg/m(2) in men and ≥110 kg/m(2) in women) as well as uncontrolled 24-h BP (mean 24-h SBP/diastolic BP (DBP) ≥130/80 mm Hg) or sleep BP (mean sleep SBP/DBP ≥120/70 mm Hg), but not uncontrolled office BP (mean office SBP/DBP ≥140/90 mm Hg), were independently associated with cognitive dysfunction (all P < 0.05).

CONCLUSIONS

Among older hypertensive patients with antihypertensive medications, those who had echocardiographically determined cardiac hypertrophy may be at high risk for cognitive dysfunction, irrespective of their office BP and 24-h BP levels.

Lack of nocturnal blood pressure fall in elderly bedridden hypertensive patients with cerebrovascular disease

To prevent recurrence of cerebrovascular disease (CVD), adequate control of blood pressure (BP) is extremely important for the treatment of hypertensive CVD patients. As absence of the nocturnal fall of BP by the expected 10-20% from daytime levels is reported to exaggerate target organ injury, 24-h ambulatory blood pressure monitoring (ABPM) was conducted, especially to obtain data during nighttime sleep. Forty-eight elderly bedridden chronic phase CVD hypertensive patients (assessed 1-3 mo after CVD accident) participated. As a group, nocturnal BP was higher than diurnal BP, whereas nocturnal pulse rate was lower than diurnal pulse rate. The nocturnal BP fall was blunted in most (∼90%) of the patients. These results suggest that to perform a rational drug treatment, it is essential to do 24-h ABPM before initiation of antihypertensive therapy in elderly bedridden hypertensive CVD patients.