Publications by authors named "Yuichiro Yano"

198 Publications

Long-term cumulative blood pressure in young adults and incident heart failure, coronary heart disease, stroke, and cardiovascular disease: The CARDIA study.

Eur J Prev Cardiol 2021 Oct;28(13):1445-1451

Johns Hopkins University, USA.

Aims: Cumulative blood pressure (BP) is a measure that incorporates the severity and duration of BP exposure. The prognostic significance of cumulative BP in young adults for cardiovascular diseases (CVDs) in comparison to BP severity alone is, however, unclear.

Methods And Results: We investigated 3667 Coronary Artery Risk Development in Young Adults participants who attended six visits over 15 years (year-0 (1985-1986), year-2, year-5, year-7, year-l0, and year-15 exams). Cumulative BP was calculated as the area under the curve (mmHg × years) from year 0 through year 15. Cox models assessed the association between cumulative BP (year 0 through year 15), current BP (year 15), and BP change (year 0 and year 15) and CVD outcomes. Mean (standard deviation) age at year 15 was 40.2 (3.6) years, 44.1% were men, and 44.1% were African-American. Over a median follow-up of 16 years, there were 47 heart failure (HF), 103 coronary heart disease (CHD), 71 stroke, and 191 CVD events. Cumulative systolic BP (SBP) was associated with HF (hazard ratio (HR) = 2.14 (1.58-2.90)), CHD (HR = 1.49 (1.19-1.87)), stroke (HR = 1.81 (1.38-2.37)), and CVD (HR = 1.73 (1.47-2.05)). For CVD, the C-statistic for SBP (year 15) was 0.69 (0.65-0.73) and change in C-statistic with the inclusion of SBP change and cumulative SBP was 0.60 (0.56-0.65) and 0.72 (0.69-0.76), respectively. For CVD, using year-15 SBP as a reference, the net reclassification index (NRI) for cumulative SBP was 0.40 (p < 0.0001) and the NRI for SBP change was 0.22 (p = 0.001).

Conclusions: Cumulative BP in young adults was associated with the subsequent risk of HF, CHD, stroke, and CVD. Cumulative BP provided incremental prognostic value and improved risk reclassification for CVD, when compared to single BP assessments or changes in BP.
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http://dx.doi.org/10.1177/2047487320915342DOI Listing
October 2021

Kidney Function and Aortic Stiffness, Pulsatility, and Endothelial Function in African Americans: The Jackson Heart Study.

Kidney Med 2021 Sep-Oct;3(5):702-711.e1. Epub 2021 Jul 14.

Department of Medicine, University of Mississippi Medical Center, Jackson, MS.

Rationale & Objective: The relation of vascular stiffness, endothelial function, and kidney function is incompletely elucidated in African Americans. Our hypothesis was that increased vascular stiffness and endothelial dysfunction are associated with low estimated glomerular filtration rate (eGFR) and albuminuria in African Americans.

Study Design: Cross-sectional cohort analysis of data from the Jackson Heart Study.

Settings & Patients: 2,244 Jackson Heart Study participants (2012-2017 after Exam 3) who had undergone noninvasive hemodynamic assessment using arterial tonometry.

Predictors: Baseline carotid-femoral pulse wave velocity, pulsatile hemodynamics forward wave amplitude, and hyperemic brachial artery flow were measured. Reduced eGFR was defined as eGFR between 15 and 60 mL/min/1.73 m.

Outcomes: Prevalent albuminuria, urinary albumin-creatinine ratio.

Analytical Approach: 2-sample test for continuous variables and χ test for categorical variables in addition to logistic and linear regression models to assess the risk for chronic kidney disease with each proposed hemodynamic variable.

Results: Among 2,244 participants, mean age was 66 ± 11 years and 64% were women. Reduced eGFR was present in 233 (10.4%), and elevated urinary albumin-creatinine ratio, in 232 (10.4%). In multivariable-adjusted analyses, higher carotid-femoral pulse wave velocity was associated with the presence of reduced eGFR (OR, 1.37 [95% CI, 1.08-1.75] per SD;  = 0.01) and with prevalent albuminuria (OR, 1.66 [95% CI, 1.32-2.11];  < 0.001). Higher forward wave amplitude was significantly associated with prevalent albuminuria (OR, 1.37 [95% CI, 1.14-1.65];  = 0.001).

Limitations: Cross-sectional analyses cannot inform causality.

Conclusions: Higher arterial stiffness and pulsatility are associated with higher odds of reduced eGFR in African Americans. Future studies should focus on whether improving arterial stiffness contributes to kidney protection in African Americans.
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http://dx.doi.org/10.1016/j.xkme.2021.03.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515070PMC
July 2021

Kidney Outcomes Associated With SGLT2 Inhibitors Versus Other Glucose-Lowering Drugs in Real-world Clinical Practice: The Japan Chronic Kidney Disease Database.

Diabetes Care 2021 Nov 30;44(11):2542-2551. Epub 2021 Sep 30.

Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan.

Objective: Randomized controlled trials have shown kidney-protective effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors, and clinical practice databases have suggested that these effects translate to clinical practice. However, long-term efficacy, as well as whether the presence or absence of proteinuria and the rate of estimated glomerular filtration rates (eGFR) decline prior to SGLT2 inhibitor initiation modify treatment efficacy among type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) patients, is unknown.

Research Design And Methods: Using the Japan Chronic Kidney Disease Database (J-CKD-DB), a nationwide multicenter CKD registry, we developed propensity scores for SGLT2 inhibitor initiation, with 1:1 matching with patients who were initiated on other glucose-lowering drugs. The primary outcome included rate of eGFR decline, and the secondary outcomes included a composite outcome of 50% eGFR decline or end-stage kidney disease.

Results: At baseline, mean age at initiation of the SGLT2 inhibitor ( = 1,033) or other glucose-lowering drug ( = 1,033) was 64.4 years, mean eGFR was 68.1 mL/min per 1.73 m, and proteinuria was apparent in 578 (28.0%) of included patients. During follow-up, SGLT2 inhibitor initiation was associated with reduced eGFR decline (difference in slope for SGLT2 inhibitors vs. other drugs 0.75 mL/min/1.73 m per year [0.51 to 1.00]). During a mean follow-up of 24 months, 103 composite kidney outcomes occurred: 30 (14 events per 1,000 patient-years) among the SGLT2 inhibitors group and 73 (36 events per 1,000 patient-years) among the other drugs group (hazard ratio 0.40, 95% CI 0.26-0.61). The benefit provided by SGLT2 inhibitors was consistent irrespective of proteinuria and rate of eGFR decline before initiation of SGLT2 inhibitors ( ≥ 0.35).

Conclusions: The benefits of SGLT2 inhibitors on kidney function as observed in clinical trials translate to patients treated in clinical practice with no evidence that the effects are modified by the underlying rate of kidney function decline or the presence of proteinuria.
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http://dx.doi.org/10.2337/dc21-1081DOI Listing
November 2021

Semiquantitative assessed proteinuria and risk of heart failure: Analysis of a nationwide epidemiological database.

Nephrol Dial Transplant 2021 Sep 7. Epub 2021 Sep 7.

The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.

Background: Heart failure (HF) is increasing in prevalence worldwide. We explored whether adults with trace and positive proteinuria were at a high risk for incident HF compared with those with negative proteinuria using a nationwide epidemiological database.

Methods: This is an obserevational cohort study using the JMDC Claims Database collected between 2005 and 2020. This is a population-based sample (n = 1,021,943; median age [interquartile range], 44 [37-52] years; 54.8% men). No participants had a known history of cardiovascular disease. Each participant was categorized into three groups according to the urine dipstick test results: negative proteinuria (n = 902,273), trace proteinuria (n = 89,599), and positive proteinuria (≥1+) (n = 30,071). The primary outcome was HF. The secondary outcomes were myocardial infarction, stroke, and atrial fibrillation. We performed multivariable Cox regression analyses to identify the association between the proteinuria category and incient HF and other cardiovascular disease events.

Results: Over a mean follow-up of 1,150 ± 920 days, 17,182 incident HF events occurred. After multivariable adjustment, hazard ratios (HRs) for HF events were 1.09 (95% confidence interval [CI], 1.03-1.15) and 1.59 (95% CI, 1.49-1.70) for trace proteinuria and positive proteinuria vs. negative proteinuria, respectively. This association was present irrespective of clinical characteristics. A stepwise increase in the risk of myocardial infarction, stroke, and atrial fibrillation with proteinuria category was also observed. Our primary results were confirmed in participants after multiple imputation for missing values and in those having no medications for hypertension, diabetes mellitus, and dyslipidemia. Discriminative predictive value for HF events improved by adding the results of urine dipstick test to traditional risk factors (net reclassification improvement 0.0497, 95% CI 0.0346-0.0648, p < 0.001).

Conclusions: Not only positive proteinuria but also trace proteinuria was associated with a greater incidence of HF in the general population. Semiquantitative assessment of proteinuria would be informative for the risk stratification of HF.
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http://dx.doi.org/10.1093/ndt/gfab248DOI Listing
September 2021

Relation of the Metabolic Syndrome to Incident Colorectal Cancer in Young Adults Aged 20 to 49 Years.

Am J Cardiol 2021 11 2;158:132-138. Epub 2021 Sep 2.

The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.

Onco-cardiology is the emerging field, and the concept of shared risk factor holds an important position in this field. The increasing prevalence of colorectal cancer (CRC) in young adults is a critical epidemiological issue. Although metabolic syndrome, which is a major risk factor for cardiovascular disease, is known to be associated with CRC incidence in middle-aged and elderly individuals, it is unclear whether this association is present in young adults. We assessed whether metabolic syndrome was associated with CRC events in young adults (aged <50 years), and whether the association differed by the definition of metabolic syndrome. We retrospectively analyzed 902,599 adults (20 to 49 years of age) enrolled in the JMDC Claims Database which is a nationwide epidemiological database in Japan between January 2005 and August 2018. Participants who had a history of CRC, colorectal polyps, or inflammatory bowel disease were excluded. Study participants were categorized into 2 groups according to the presence of metabolic syndrome, defined using the Japanese criteria (waist circumference ≥85 cm for men and ≥90 cm for women, and ≥2 metabolic parameters including elevated blood pressure, elevated triglycerides, reduced high-density lipoprotein cholesterol, or elevated fasting plasma glucose). Clinical outcomes were collected between January 2005 and August 2018. The primary outcome was CRC of any stage. Median (interquartile range) age was 41 (37 to 45), and 55.4% were men. Over a median follow-up of 1,008 (429 to 1,833) days, there were 1,884 incidences of CRC. After multivariable adjustment, the hazard ratio (HR) of metabolic syndrome for CRC events was 1.26 (95% confidence interval [CI] = 1.07 to 1.49). Cox regression analysis after multiple imputation for missing values showed that metabolic syndrome was associated with CRC incidence (HR = 1.35, 95% CI = 1.17 to 1.56). Metabolic syndrome was also associated with a higher incidence of CRC in individuals with a follow-up period of ≥365 days (HR = 1.33, 95% CI = 1.10 to 1.60). This association was observed when metabolic syndrome was defined according to the International Diabetes Federation criteria (HR = 1.30, 95% CI = 1.09 to 1.55) and the National Cholesterol Education Program Adult Treatment Panel III criteria (HR = 1.39, 95% CI = 1.12 to 1.72). In conclusion, metabolic syndrome was associated with a higher incidence of CRC among individuals aged <50 years. These results could be informative for risk stratification of subsequent CRC among young adults.
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http://dx.doi.org/10.1016/j.amjcard.2021.07.049DOI Listing
November 2021

Association of achieved blood pressure after treatment for primary aldosteronism with long-term kidney function.

J Hum Hypertens 2021 Aug 30. Epub 2021 Aug 30.

Clinical Research Institute of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.

Little is known regarding the association of blood pressure (BP) after treatment for primary aldosteronism (PA) (i.e., adrenalectomy and mineralocorticoid receptor antagonists) with long-term renal outcomes, and whether the association is independent of BP before treatment. Using a dataset from a nationwide registry of PA in Japan, we assessed whether achieved BP levels 6 months after treatment for PA are associated with annual changes in estimated glomerular filtration rate (eGFR), rapid eGFR decline, and incident chronic kidney disease (CKD) during the 5-year follow-up period. The cohort included 1266 PA patients. In multivariable linear regression including systolic BP (SBP) levels before treatment for PA, estimates (95% confidence interval [CI]) for annual changes in eGFR after month 6 associated with one-standard deviation (1-SD) higher SBP at month 6 were -0.08 (-0.15, -0.02) mL/min/1.73 m/year. After multivariable adjustment, the estimate (95% CI) for annual changes in eGFR after month 6 was -0.12 (-0.21, -0.02) for SBP ≥ 130 mmHg vs. SBP < 130 mmHg at month 6. Among 537 participants without CKD at baseline, a 1-SD higher SBP was associated with a higher risk for incident CKD events (hazard ratio [95% CI]: 1.40 [1.00, 1.94]). Higher SBP after treatment for PA was associated with a higher risk for kidney dysfunction over time, independently of BP levels before treatment. Achieving SBP lower than 130 mmHg after treatment for PA may be linked to better kidney outcomes.
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http://dx.doi.org/10.1038/s41371-021-00595-4DOI Listing
August 2021

Number and timing of ambulatory blood pressure monitoring measurements.

Hypertens Res 2021 Aug 11. Epub 2021 Aug 11.

Department of Medicine, Columbia University Irving Medical Center, New York City, NY, USA.

Ambulatory blood pressure (BP) monitoring (ABPM) may cause sleep disturbances. Some home BP monitoring (HBPM) devices obtain a limited number of BP readings during sleep and may be preferred to ABPM. It is unclear how closely a few BP readings approximate a full night of ABPM. We used data from the Jackson Heart (N = 621) and Coronary Artery Risk Development in Young Adults (N = 458) studies to evaluate 74 sampling approaches to estimate BP during sleep. We sampled two to four BP measurements at specific times from a full night of ABPM and computed chance-corrected agreement (i.e., kappa) of nocturnal hypertension (i.e., mean asleep systolic BP ≥ 120 mmHg or diastolic BP ≥ 70 mmHg) defined using the full night of ABPM and subsets of BP readings. Measuring BP at 2, 3, and 4 h after falling asleep, an approach applied by some HBPM devices obtained a kappa of 0.81 (95% confidence interval [CI]: 0.78, 0.85). The highest kappa was obtained by measuring BP at 1, 2, 4, and 5 h after falling asleep: 0.84 (95% CI: 0.81, 0.87). In conclusion, measuring BP three or four times during sleep may have high agreement with nocturnal hypertension status based on a full night of ABPM.
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http://dx.doi.org/10.1038/s41440-021-00717-yDOI Listing
August 2021

Fasting Plasma Glucose and Incident Colorectal Cancer: Analysis of a Nationwide Epidemiological Database.

J Clin Endocrinol Metab 2021 Jun 25. Epub 2021 Jun 25.

Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan.

Context: Although diabetes mellitus (DM) was reported to be associated with incident colorectal cancer (CRC), the detailed association between fasting plasma glucose (FPG) and incident CRC has not been fully understood.

Objective: We assessed whether hyperglycemia is associated with a higher risk for CRC.

Design: Analyses were conducted using the JMDC Claims Database [n = 1 441 311; median age (interquartile range), 46 (40-54) years; 56.6% men). None of the participants were taking antidiabetic medication or had a history of CRC, colorectal polyps, or inflammatory bowel disease. Participants were categorized as normal FPG (FPG level < 100 mg/dL; 1 125 647 individuals), normal-high FPG (FPG level = 100-109 mg/dL; 210 365 individuals), impaired fasting glucose (IFG; FPG level = 110-125 mg/dL; 74 836 individuals), and DM (FPG level ≥ 126 mg/dL; 30 463 individuals).

Results: Over a mean follow-up of 1137 ± 824 days, 5566 CRC events occurred. After multivariable adjustment, the hazard ratios for CRC events were 1.10 (95% CI 1.03-1.18) for normal-high FPG, 1.24 (95% CI 1.13-1.37) for IFG, and 1.36 (95% CI 1.19-1.55) for DM vs normal FPG. We confirmed this association in sensitivity analyses excluding those with a follow-up of< 365 days and obese participants.

Conclusion: The risk of CRC increased with elevated FPG category. FPG measurements would help to identify people at high-risk for future CRC.
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http://dx.doi.org/10.1210/clinem/dgab466DOI Listing
June 2021

Comparison of Brachial Blood Pressure and Central Blood Pressure in Attended, Unattended, and Unattended Standing Situations.

Hypertens Res 2021 Oct 30;44(10):1283-1290. Epub 2021 Jul 30.

Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.

Central systolic blood pressure (cSBP) is an independent predictor of future cardiovascular disease. Unattended brachial SBP (bSBP) can eliminate the white-coat effect. However, unattended cSBP and unattended standing cSBP have never been reported. We aimed to compare bSBP and cSBP in attended, unattended, and unattended standing situations. We also aimed to compare the white-coat effect and unattended orthostatic BP change between bSBP and cSBP. Altogether, 104 hypertensive outpatients were included (mean age: 66.0 ± 9.8 years, 41.3% male, mean body mass index: 25.0 ± 4.5). Attended bSBP/cSBP values were 127.3 ± 15.7/119.2 ± 15.0, unattended bSBP/cSBP values were 122.7 ± 15.3/114.4 ± 15.1, and unattended standing bSBP/cSBP values were 123.6 ± 15.7/114.1 ± 14.8 mmHg (correlation coefficients/coefficients of determination between bSBP and cSBP: 0.971/0.943, 0.970/0.941, and 0.964/0.929, respectively; all p < 0.001). No significant difference was observed in the white-coat effect between bSBP and cSBP (4.6 ± 5.8 vs. 4.8 ± 5.7 mmHg). Although there was no significant difference between unattended sitting SBP and unattended standing SBP in terms of both bSBP and cSBP, a numerically small but significant difference was observed in the unattended orthostatic BP change between bSBP and cSBP (0.9 ± 8.0 vs. -0.3 ± 9.0 mmHg, p = 0.002). In conclusion, significant and strong correlations were observed between bSBP and cSBP in attended, unattended, and unattended standing BP measurements. The white-coat effect on bSBP was equivalent to that on cSBP. There was a numerically small but significant difference in the unattended orthostatic BP change between bSBP and cSBP.
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http://dx.doi.org/10.1038/s41440-021-00694-2DOI Listing
October 2021

Does This Adult Patient Have Hypertension?: The Rational Clinical Examination Systematic Review.

JAMA 2021 07;326(4):339-347

Department of Medicine, Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill.

Importance: Office blood pressure (BP) measurements are not the most accurate method to diagnose hypertension. Home BP monitoring (HBPM) and 24-hour ambulatory BP monitoring (ABPM) are out-of-office alternatives, and ABPM is considered the reference standard for BP assessment.

Objective: To systematically review the accuracy of oscillometric office and home BP measurement methods for correctly classifying adults as having hypertension, defined using ABPM.

Data Sources: PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and DARE databases and the American Heart Association website (from inception to April 2021) were searched, along with reference lists from retrieved articles.

Data Extraction And Synthesis: Two authors independently abstracted raw data and assessed methodological quality. A third author resolved disputes as needed.

Main Outcomes And Measures: Random effects summary sensitivity, specificity, and likelihood ratios (LRs) were calculated for BP measurement methods for the diagnosis of hypertension. ABPM (24-hour mean BP ≥130/80 mm Hg or mean BP while awake ≥135/85 mm Hg) was considered the reference standard.

Results: A total of 12 cross-sectional studies (n = 6877) that compared conventional oscillometric office BP measurements to mean BP during 24-hour ABPM and 6 studies (n = 2049) that compared mean BP on HBPM to mean BP during 24-hour ABPM were included (range, 117-2209 participants per analysis); 2 of these studies (n = 3040) used consecutive samples. The overall prevalence of hypertension identified by 24-hour ABPM was 49% (95% CI, 39%-60%) in the pooled studies that evaluated office measures and 54% (95% CI, 39%-69%) in studies that evaluated HBPM. All included studies assessed sensitivity and specificity at the office BP threshold of 140/90 mm Hg and the home BP threshold of 135/85 mm Hg. Conventional office oscillometric measurement (1-5 measurements in a single visit with BP ≥140/90 mm Hg) had a sensitivity of 51% (95% CI, 36%-67%), specificity of 88% (95% CI, 80%-96%), positive LR of 4.2 (95% CI, 2.5-6.0), and negative LR of 0.56 (95% CI, 0.42-0.69). Mean BP with HBPM (with BP ≥135/85 mm Hg) had a sensitivity of 75% (95% CI, 65%-86%), specificity of 76% (95% CI, 65%-86%), positive LR of 3.1 (95% CI, 2.2-4.0), and negative LR of 0.33 (95% CI, 0.20-0.47). Two studies (1 with a consecutive sample) that compared unattended automated mean office BP (with BP ≥135/85 mm Hg) with 24-hour ABPM had sensitivity ranging from 48% to 51% and specificity ranging from 80% to 91%. One study that compared attended automated mean office BP (with BP ≥140/90 mm Hg) with 24-hour ABPM had a sensitivity of 87.6% (95% CI, 83%-92%) and specificity of 24.1% (95% CI, 16%-32%).

Conclusions And Relevance: Office measurements of BP may not be accurate enough to rule in or rule out hypertension; HBPM may be helpful to confirm a diagnosis. When there is uncertainty around threshold values or when office and HBPM are not in agreement, 24-hour ABPM should be considered to establish the diagnosis.
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http://dx.doi.org/10.1001/jama.2021.4533DOI Listing
July 2021

Decision Tree-Based classification for maintaining normal blood pressure throughout middle age: findings from the Coronary Artery Risk Development in Young Adults study.

Am J Hypertens 2021 Jun 27. Epub 2021 Jun 27.

Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, IL.

Background: For most individuals, blood pressure (BP) is related to multiple risk factors. By utilizing the decision tree analysis technique, this study aimed to identify the best discriminative risk factors and interactions that are associated with maintaining normal BP over 30 years, and to reveal segments of a population with a high probability of maintaining normal BP.

Methods: Participants from the Coronary Artery Risk Development in Young Adults study aged 18 to 30 years with normal BP level at baseline visit (Y0, 1985-6) were included in this study.

Results: Of 3156 participants, 1132 (35.9%) maintained normal BP during the follow-up period and 2024 (64.1%) developed higher BP. Systolic BP within the normal range, race, and body mass index (BMI) were the most discriminative factors between participants who maintained normal BP throughout midlife and those who developed higher BP. Participants with a baseline systolic BP level ≤92 mmHg and White women with baseline BMI<23 kg/m 2 were the two segments of the population with the highest probability for maintaining normal BP throughout midlife (69.2% and 59.9%, respectively). Among Black participants aged >26.5 years with BMI>27 kg/m 2, only 5.4% of participants maintained normal BP throughout midlife.

Conclusions: This study emphasizes the importance of early life factors to later life systolic BP and support efforts to maintain ideal levels of risk factors for hypertension at young ages. Whether policies to maintain lower BMI and SBP well below the clinical thresholds throughout young adulthood and middle-age can reduce later age hypertension should be examined in future studies.
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http://dx.doi.org/10.1093/ajh/hpab099DOI Listing
June 2021

Fasting Plasma Glucose and Incident Colorectal Cancer: Analysis of a Nationwide Epidemiological Database Fasting Plasma Glucose and Colorectal Cancer.

J Clin Endocrinol Metab 2021 Jun 25. Epub 2021 Jun 25.

The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.

Context: Although diabetes mellitus (DM) was reported to be associated with incident colorectal cancer (CRC), the detailed association between fasting plasma glucose (FPG) and incident CRC has not been fully understood.

Objective: We assessed whether hyperglycemia is associated with a higher risk for CRC.

Design: Analyses were conducted using the JMDC Claims Database (n=1,441,311; median age [IQR], 46 [40-54] years; 56.6% men). None of the participants were taking antidiabetic medication or had a history of CRC, colorectal polyps, or inflammatory bowel disease. Participants were categorized as normal FPG, FPG level<100 mg/dL (1,125,647 individuals); normal-high FPG, FPG level=100-109 mg/dL (210,365 individuals); impaired fasting glucose (IFG), FPG level=110-125 mg/dL (74,836 individuals); and DM, FPG level≥126 mg/dL (30,463 individuals).

Results: Over a mean follow-up of 1,137±824 days, 5,566 CRC events occurred. After multivariable adjustment, the hazard ratios for CRC events were 1.10 (95% CI,1.03-1.18) for normal-high FPG, 1.24 (95% CI, 1.13-1.37) for IFG, and 1.36 (95% CI, 1.19-1.55) for DM vs. normal FPG. We confirmed this association in sensitivity analyses excluding those with a follow-up of< 365 days, and or with obese participants.

Conclusion: The risk of CRC increased with elevated FPG category. FPG measurements would help identifying people at high-risk for future CRC.
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http://dx.doi.org/10.1210/clinem/dgab466DOI Listing
June 2021

Relation of Serum Uric Acid and Cardiovascular Events in Young Adults Aged 20-49 Years.

Am J Cardiol 2021 08 14;152:150-157. Epub 2021 Jun 14.

The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.

Serum uric acid (SUA) was reported to be associated with incident cardiovascular disease (CVD). However, the relationship between SUA and CVD among young adults has not been clarified yet. In this study, we aimed to identify the association of medication naïve SUA with incident CVD including myocardial infarction (MI), stroke, heart failure (HF) and atrial fibrillation (AF) using a nationwide epidemiological database. We analyzed 353,613 participants aged 20-49 years, who were not taking UA lowering medications, and had no prevalent history of cardiovascular disease (CVD) using a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018. Median [interquartile range] age was 40 [34-44] years, and 46.9% were men. Over a mean follow-up of 1,176±876 days, 391 (0.1%) incident MI, 1,308 (0.4%) incident stroke, 3,374 (1.0%) incident HF, and 684 (0.2%) incident AF events occurred. Kaplan-Meier curves and the log-rank test showed that there was a significant difference in incident MI, stroke, HF, and AF among the groups based on SUA tertile (all log-rank p< 0.001). Multivariable Cox regression analysis showed that the upper tertile of SUA (SUA ≥ 5.7 mg/dL) was associated with higher incidence of MI (HR 1.45, 95% CI 1.00-2.10), HF (HR 1.13, 95% CI 1.01-1.28), and AF (HR 1.35, 95% CI 1.02-1.78) compared with the first tertile of SUA (SUA < 4.4 mg/dL). SUA as continuous variable was independently associated with incident MI (HR 1.10, 95% CI 1.00-1.20), stroke (HR 1.06, 95% CI 1.00-1.11), HF (HR 1.07, 95% CI 1.03-1.10), and AF (HR 1.11, 95% CI 1.04-1.19). SUA ≥ 7.0 mg/dL was independently associated with incident HF (HR 1.24, 95% CI 1.12-1.38). In conclusion, higher SUA was associated with increased incidence of CVD events in individuals aged< 50 years, suggesting the potential significance of the optimal UA control for the primary CVD prevention even in young adults.
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http://dx.doi.org/10.1016/j.amjcard.2021.05.007DOI Listing
August 2021

Associations of Ideal Cardiovascular Health and Its Change During Young Adulthood With Premature Cardiovascular Events: A Nationwide Cohort Study.

Circulation 2021 Jul 14;144(1):90-92. Epub 2021 Jun 14.

Department of Preventive Medicine (H.L., S.M.J.C., H.-H.L., H.C.K.), Yonsei University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.121.054212DOI Listing
July 2021

Serum Urate Trajectory in Young Adulthood and Incident Cardiovascular Disease Events by Middle Age: CARDIA Study.

Hypertension 2021 Nov 7;78(5):1211-1218. Epub 2021 Jun 7.

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (N.M., D.R.J.).

[Figure: see text].
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.121.17555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8516664PMC
November 2021

Association Between Blood Pressure Classification Using the 2017 ACC/AHA Blood Pressure Guideline and Retinal Atherosclerosis.

Am J Hypertens 2021 May 19. Epub 2021 May 19.

The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.

Background: We aimed to explore the association between the blood pressure (BP) classification defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the prevalence of retinal atherosclerosis.

Methods: This study was a retrospective observational cross-sectional analysis using the JMDC Claims Database. We analyzed 280,599 subjects not taking any antihypertensive medications. According to the 2017 ACC/AHA guideline, each subject was categorized as having normal BP (n=159,524), elevated BP (n=35,603), stage 1 hypertension (n=54,795), or stage 2 hypertension (n=30,677) using the BP value at the initial health check-up. Retinal photographs were assessed according to the Keith-Wagener-Barker system.

Results: The median age was 46 years, and 50.4% subjects were men. Retinal atherosclerosis, defined as Keith-Wagener-Barker system grade ≥1, was observed in 3.2% in normal BP, 5.2% in elevated BP, 7.7% in stage 1 hypertension, and 18.7% in stage 2 hypertension. Compared with normal BP, elevated BP (OR;1.30, 95% CI;1.23-1.38), stage 1 hypertension (OR;1.71, 95% CI;1.64-1.79), and stage 2 hypertension (OR;4.10, 95% CI;3.93-4.28) were associated with a higher prevalence of retinal atherosclerosis. Among 92,121 subjects without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol consumption, elevated BP (OR;1.34, 95% CI;1.19-1.51), stage 1 hypertension (OR;1.79, 95% CI;1.61-1.98), and stage 2 hypertension (OR;4.42, 95% CI;4.00-4.92) were associated with a higher prevalence of retinal atherosclerosis. This association was observed in all subgroups stratified by age or sex.

Conclusions: Our investigation suggests that retinal atherosclerosis could start even in individuals with elevated BP and stage 1 hypertension.
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http://dx.doi.org/10.1093/ajh/hpab074DOI Listing
May 2021

Reflection-type vapor cell for micro atomic clocks using local anodic bonding of 45° mirrors.

Opt Lett 2021 May;46(10):2272-2275

This Letter reports the design, fabrication, and evaluation of reflection-type planar vapor cells for chip-scale atomic clocks. The cell with 2-8 mm cavity length contains two 45° Bragg reflector mirrors assembled using a local anodic bonding. Coherent population trapping resonance of Rb atoms is observed, realizing an atomic clock operation. Allan deviations at an averaging time of 1 s are ${2.2} \times {{1}}{{{0}}^{- 10}}$ and ${9.5} \times {{1}}{{{0}}^{- 11}}$ for 2 mm long and 6 mm long vapor cells, respectively. These results show that planar vapor cells compatible with a system-in-package are feasible without degradation of clock stabilities compared to conventional vertically stacked cells.
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http://dx.doi.org/10.1364/OL.424354DOI Listing
May 2021

USPSTF Recommendations for Screening for Hypertension in Adults: It Is Time to Unmask Hypertensive Risk.

JAMA Cardiol 2021 Aug;6(8):869-871

Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

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http://dx.doi.org/10.1001/jamacardio.2021.1122DOI Listing
August 2021

Association of Blood Pressure Classification Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline With Risk of Heart Failure and Atrial Fibrillation.

Circulation 2021 Jun 22;143(23):2244-2253. Epub 2021 Apr 22.

Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan.

Background: Heart failure (HF) and atrial fibrillation (AF) are growing in prevalence worldwide. Few studies have assessed to what extent stage 1 hypertension in the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines is associated with incident HF and AF.

Methods: Analyses were conducted with a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018 (n=2 196 437; mean age, 44.0±10.9 years; 58.4% men). No participants were taking antihypertensive medication or had a known history of cardiovascular disease. Each participant was categorized as having normal BP (systolic BP <120 mm Hg and diastolic BP <80 mm Hg; n=1 155 885), elevated BP (systolic BP 120-129 mm Hg and diastolic BP <80 mm Hg; n=337 390), stage 1 hypertension (systolic BP 130-139 mm Hg or diastolic BP 80-89 mm Hg; n=459 820), or stage 2 hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg; n=243 342). Using Cox proportional hazards models, we identified associations between BP groups and HF/AF events. We also calculated the population attributable fractions to estimate the proportion of HF and AF events that would be preventable if participants with stage 1 and stage 2 hypertension were to have normal BP.

Results: Over a mean follow-up of 1112±854 days, 28 056 incident HF and 7774 incident AF events occurred. After multivariable adjustment, hazard ratios for HF and AF events were 1.10 (95% CI, 1.05-1.15) and 1.07 (95% CI, 0.99-1.17), respectively, for elevated BP; 1.30 (95% CI, 1.26-1.35) and 1.21 (95% CI, 1.13-1.29), respectively, for stage 1 hypertension; and 2.05 (95% CI, 1.97-2.13) and 1.52 (95% CI, 1.41-1.64), respectively, for stage 2 hypertension versus normal BP. Population attributable fractions for HF associated with stage 1 and stage 2 hypertension were 23.2% (95% CI, 20.3%-26.0%) and 51.2% (95% CI, 49.2%-53.1%), respectively. The population attributable fractions for AF associated with stage 1 and stage 2 hypertension were 17.4% (95% CI, 11.5%-22.9%) and 34.3% (95% CI, 29.1%-39.2%), respectively.

Conclusions: Both stage 1 hypertension and stage 2 hypertension were associated with a greater incidence of HF and AF in the general population. The American College of Cardiology/American Heart Association BP classification system may help identify adults at higher risk for HF and AF events.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.052624DOI Listing
June 2021

Association of aldosterone and blood pressure with the risk for cardiovascular events after treatments in primary aldosteronism.

Atherosclerosis 2021 05 29;324:84-90. Epub 2021 Mar 29.

Clinical Research Institute of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan.

Background And Aims: We used a dataset from a Japanese nationwide registry of patients with primary aldosteronism, to determine which of the parameters of hyperaldosteronism and blood pressure before or after treatments for primary aldosteronism (i.e., surgical adrenalectomy or a medication treatment) are important in terms of cardiovascular prognosis.

Methods: We assessed whether plasma aldosterone-to-renin ratio and pulse pressure levels before treatment and 6 months after treatment were associated with composite cardiovascular disease events during the 5-year follow-up period.

Results: The cohort included 1987 patients (mean age was 53.2 years, 52.0% were female, 37.2% had undergone surgical treatment, and the remainder had been treated with mineralocorticoid receptor antagonists). In the Cox proportional hazard model, the covariate-adjusted hazard ratio (95% confidence interval) for the composite cardiovascular disease events risk for each one-standard-deviation increase in the aldosterone-to-renin ratio or pulse pressure before treatment, those after treatment, or the duration of hypertension were 1.24 (1.05, 1.48), 0.74 (0.54, 1.02), and 1.07 (0.79, 1.44), 1.43 (1.07, 1.92), and 1.52 (1.19, 1.95), respectively. Patients with a high pre-treatment aldosterone-to-renin ratio of more than 603 and a large post-treatment pulse pressure of more than 49 mmHg showed approximately three-fold higher hazard ratios for cardiovascular events risk compared to those with a lower aldosterone-to-renin ratio and smaller pulse pressure.

Conclusions: Higher aldosterone-to-renin ratio before treatments, higher pulse pressure after treatments, and longer duration of hypertension were prognostic factors for cardiovascular diseases. Early intervention may be important for preventing cardiovascular disease among patients with primary aldosteronism.
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http://dx.doi.org/10.1016/j.atherosclerosis.2021.03.033DOI Listing
May 2021

Blood Pressure in Young Adults and Cardiovascular Disease Later in Life.

Authors:
Yuichiro Yano

Am J Hypertens 2021 04;34(3):250-257

Center for Novel and Exploratory Clinical Trials, Yokohama City University, Kanagawa, Japan.

Cardiovascular disease (CVD) mortality has declined markedly over the past several decades among middle-age and older adults in the United States. However, young adults (18-39 years of age) have had a lower rate of decline in CVD mortality. This trend may be related to the prevalence of high blood pressure (BP) having increased among young US adults. Additionally, awareness, treatment, and control of hypertension are low among US adults between 20 and 39 years of age. Many young adults and healthcare providers may not be aware of the impact of high BP during young adulthood on their later life, the associations of BP patterns with adverse outcomes later in life, and benefit-to-harm ratios of pharmacological treatment. This review provides a synthesis of the related resources available in the literature to better understand BP-related CVD risk among young adults and better identify BP patterns and levels during young adulthood that are associated with CVD events later in life, and lastly, to clarify future challenges in BP management for young adults.
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http://dx.doi.org/10.1093/ajh/hpab005DOI Listing
April 2021

Blood Pressure Levels in Young Adulthood and Midlife Stroke Incidence in a Diverse Cohort.

Hypertension 2021 May 29;77(5):1683-1693. Epub 2021 Mar 29.

Division of Research, Kaiser Permanente Northern California, Oakland (Y.G., J.S.R., M.N.N.-H., S.S.).

[Figure: see text].
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035276PMC
May 2021

Gut Microbiome over a Lifetime and the Association with Hypertension.

Curr Hypertens Rep 2021 03 8;23(3):15. Epub 2021 Mar 8.

Department of Internal Medicine, University of Turku, Turku, Finland.

Purpose Of Review: Microorganisms living within an ecosystem create microbial communities and play key roles in ecosystem functioning. During their lifespan, humans share their bodies with a variety of microorganisms. More than 10-100 trillion symbiotic microorganisms live on and within human beings, and the majority of these microorganisms populate the distal ileum and colon (referred to as the gut microbiota). Interactions between the gut microbiota and the host involve signaling via chemical neurotransmitters and metabolites, neuronal pathways, and the immune system. Hypertension is a complex and heterogeneous pathophenotype. A reductionist approach that assumes that all patients who have the same signs of a disease share a common disease mechanism and thus should be treated similarly is insufficient for optimal blood pressure management. Herein, we have highlighted the contribution of the gut microbiome to blood pressure regulation in humans.

Recent Findings: Gut dysbiosis-an imbalance in the composition and function of the gut microbiota-has been shown to be associated with hypertension. Gut dysbiosis occurs via environmental pressures, including caesarean section, antibiotic use, dietary changes, and lifestyle changes over a lifetime. This review highlights how gut dysbiosis may affect a host's blood pressure over a lifetime. The review also clarifies future challenges in studies of associations between the gut microbiome and hypertension.
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http://dx.doi.org/10.1007/s11906-021-01133-wDOI Listing
March 2021

Adherence to Antihypertensive Medication and Incident Cardiovascular Events in Young Adults With Hypertension.

Hypertension 2021 04 1;77(4):1341-1349. Epub 2021 Mar 1.

From the Department of Preventive Medicine (H.L., H.C.K.), Yonsei University College of Medicine, Seoul, Korea.

[Figure: see text].
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16784DOI Listing
April 2021

Response by Lee et al to Letter Regarding Article, "Cardiovascular Risk of Isolated Systolic or Diastolic Hypertension in Young Adults".

Circulation 2021 Jan 19;143(3):e22-e23. Epub 2021 Jan 19.

Department of Preventive Medicine (H.L., H.C.K.), Yonsei University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.051719DOI Listing
January 2021

Early-but Not Late-Onset Hypertension Is Related to Midlife Cognitive Function.

Hypertension 2021 03 19;77(3):972-979. Epub 2021 Jan 19.

From the Division of Medicine, Turku University Hospital, University of Turku, Finland (K.S., T.J.N.).

Hypertension is related to increased risk of cognitive decline in a highly age-dependent manner. However, conflicting evidence exists on the relation between age of hypertension onset and cognition. Our goal was to investigate the association between early- versus late-onset hypertension and midlife cognitive performance in 2946 CARDIA study (Coronary Artery Risk Development in Young Adults) participants (mean age 55±4, 57% women). The participants underwent 9 repeat examinations, including blood pressure measurements, between 1985 to 1986 and 2015 to 2016. The participants underwent brain magnetic resonance imaging and completed Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Stroop interference test, and the Montreal Cognitive Assessment to evaluate cognitive function at the year 30 exam. We assessed the relation between age of hypertension onset and cognitive function using linear regression models adjusted for cognitive decline risk factors, including systolic blood pressure. We observed that individuals with early-onset hypertension (onset at <35 years) had 0.24±0.09, 0.22±0.10, 0.27±0.09, and 0.19±0.07 lower standardized Z-scores in Digit Symbol Substitution Test, Stroop test, Montreal Cognitive Assessment, and a composite cognitive score than participants without hypertension (<0.05 for all). In contrast, hypertension onset at ≥35 years was not associated with cognitive function (>0.05 for all). In a subgroup of 559 participants, neither early- nor late-onset hypertension was related to macrostructural brain alterations (>0.05 for all). Our results indicate that early-onset hypertension is a potent risk factor for midlife cognitive impairment. Thus, age of hypertension onset assessment in clinical practice could improve risk stratification of cognitive decline in patients with hypertension.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878356PMC
March 2021

Clinical results of reverse shoulder arthroplasty for comminuted proximal humerus fractures in elderly patients: a comparison between nonporous stems versus trabecular metal stems.

JSES Int 2020 Dec 6;4(4):952-958. Epub 2020 Oct 6.

Department of Orthopaedics, Jichi Medical University Hospital, Tochigi, Japan.

Background: This study compared the clinical results for nonporous stems vs. trabecular metal (TM) stems used in reverse shoulder arthroplasty (RSA) for comminuted proximal humeral fractures (CPHFs) in elderly patients.

Methods: In this retrospective study, a total of 41 shoulders (39 women) of patients with CPHF aged >70 years who underwent RSA were investigated. The minimum follow-up period was 2 years. A total of 15 shoulders were treated with Grammont-style RSA using nonporous stems (the G-RSA group), and 26 shoulders were treated with RSA combining TM stems (the FR-RSA group). The American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant score, shoulder joint range of motion (ROM), and radiographic findings were compared between the 2 groups.

Results: ASES scores and Constant scores were significantly higher in the FR-RSA group than in the G-RSA group. External rotation at the side in the FR-RSA group was significantly higher than that in the G-RSA group. In the FR-RSA and G-RSA groups, the union rates at the greater tuberosity (GT) were 88.5% and 46.7%, respectively, and scapular notching rates were 20% and 7.7%, respectively. Based on a subanalysis, the age was lower, body mass index was higher, and ASES scores, Constant scores, and external rotation ROM were higher in the GT union group than in the GT nonunion group.

Conclusion: GT bone union rates were high, and external rotation ROM of the shoulder joint were more improved for RSA using TM stems than those for RSA using nonporous stems in elderly patients with CPHF.
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http://dx.doi.org/10.1016/j.jseint.2020.08.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738571PMC
December 2020
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