Daily News -- Topics of the presentations of yesterday -- ICPC IHHC May 30 (Wednesday)
PL-III Plenary SessionPractical implication of new risk factors for prevention in the general publicOestrogen and cardiovascular disease in womenKay-Tee Khaw, UK • The excess rate in men compared to women for coronary heart disease (CHD) rates suggests that oestrogen might be protective for CHD. Many observational studies have indicated that women using postmenopausal oestrogen replacement therapy had lower CHD mortality. Randomized intervention trials of exogenous oestrogen (e.g. PEPI) have demonstrated many biological effects in women including lowering of LDL cholesterol and increase of HDL cholesterol levels, decreased vascular resistance and improved endothelial function. However, trials of postmenopausal hormone replacement therapy, notably in HERS study, have not shown any beneficial effects on cardiovascular endpoints or overall mortality. • There is no evidence to date that widespread postmenopausal hormone replacement therapy will be of benefit for cardiovascular disease prevention in women in the general population. Additionally, it is notable that populations where rates of CHD are low such as in Japan, are also populations in which endogenous oestrogen levels are generally lower than Western populations. Beneficial effects of oestrogen on lipids may be counterbalanced by adverse effects on other risk factors, especially thrombosis. We will await results or primary prevention trial.
PL-IV Plenary SessionTrends in Cigarette smoking and Changes in Coronary Heart Disease MortalityUlrich Keil, Germany • Data from 8 MONICA Ausburg centers (1984/85, registration period 1984-95) were analyzed for CHD rates. Smoking, among the three classical risk factors (high BP, high Cholesterol and smoking), turned out as the major determinant of CHD changes. Rate advance period (RAP) for CHD for smokers was approximately 11 years. This means, for example, 50-year old smokers are expected to carry the same risk of CHD as 61-year old non-smokers. • Smoking rate for the MONICA Ausburg centers decreased from 35.7% to 31.2%, from 1984 to 1995.
S-12 SymposiumIndustrial health and CVDM Kornitzer, T Okubo, K, Hirobe, PL Schnall, M MarmotWork-related CVD prevention, including psychological job characteristics, should be "stressed"! • A US well-designed prospective study has clearly indicated that job strain--a combination of psychological job demands and low control over job--predicts ambulatory blood pressure levels. The famous Whitehall II study, which has already shown the importance of job control on CVD incidence in the British civil servants, indicates the significance of the lower control at home as well in relation to gender issues. Considering the strong evidence regarding job characteristics on CVD, work place intervention is the urgent issue. In this symposium, a comprehensive review of work-place interventions was also introduced. Although no consistent intervention has been practiced so far, the development of the effective methodology is a great challenge to us. Substantially lower incidence of myocardial infarction has been shown in Japanese working populations. Yet, considering the economic globalization, job insecurity following the economic recession, etc, the work-related CVD prevention is a worldwide issue, which should not be overlooked.
S-13 SymposiumIn Putting Heart Health on the social and political agendaHeart health - Key to global public healthPM Puska, WHO, Geneva • Non-communicable disease, NCD is now a major burden for human health. • In 1999, NCD was responsible for 60% of all deaths, and half of those were due to cardiovascular diseases. Therefore Heart Health is the mainstream of contemporary public health. There are so many misconceptions about Heart Health, such as that NCD are mainly a problem of industrialized countries, that NCD is a matter of national policy, not of international policy. But all are wrong. For instance, NCD -related life styles have a strong international background such as smoking. We need community-based NCD preventions. WHO can work with international partnership through evidence-based strategy. The speaker emphasizes that risk factor monitoring is quite important, and WHO should work together with collaborating centers, NGOs, other UN agencies for the purpose.
S-14 SymposiumFindings from the INTERMAP StudyJ Stamler, B Zhou, P Elliot, and H Ueshima • In this symposium on May 29, four papers from the INTERMAP Study, an international cooperative study on nutrient intake and blood pressure (BP), were reported. • First, Dr. Stamler (USA) demonstrated the background, aims, and methods of the study, in which 17 sample cross-sectional populations of 4,700 men and women aged 40-59 in 4 countries (China, Japan, UK, and USA), were investigated. He also reported the significant inverse relationship of education to BP. The size of the education-BP coefficient reduced by multivariate-adjustment including dietary variables, suggesting education-nutrient interaction to BP. • Dr. Zhou (China) reported descriptive findings on nutrient intake among 4 countries. Intakes of carbohydrate, starch, vegetable protein, and sodium were higher in Asian countries. Intakes of total fat, saturated fatty acids, animal protein, and potassium were higher in Western countries. Calcium and selenium intakes were lowest in China. • Dr. Elliot (UK) reported the relationship of dietary protein intake of individuals to their BP among all participants. There was a significant inverse relationship between vegetable protein intake and BP even after multivariate adjustment. • Dr. Ueshima (Japan) reported the relationship of dietary lipid intake to BP. The relationships were inconsistent by adjustment of other factors, but an independent inverse relationship between omega-3 fatty acids and BP was observed.
S-15 SymposiumObesity and insulin resistanceS Julius • Professor S.Julius proposed that insulin resistance(I), sympathetic nerve system(S), and hemodynamics(H) could constitute circular phenomenon, instead of linear association. I I → S → H H S
S-16 SymposiumKawasaki Disease: Clinical Pictures and EpidemiologyChairpersons: M Takahashi, H YanagawaT Kawasaki, M Takahashi, T Sonobe, H Lue, Y Nakamura • Clinical pictures and epidemiology of Kawasaki disease were presented from U.S.A., Taiwan and Japan. Dr. Zhang took part in and reported epidemiology of Kawasaki disease in China. Kawasaki disease is an acute febrile mucocutaneous lymph node syndrome with multisystem vasculitis mainly affecting infants and small children under 5 years of age. The Most important event is cardiac sequelae, and their long-term prognosis is unknown. The original description of the disease was made in 1967 by Dr. Kawasaki. Dr. Kawasaki himself presented clinical pictures of Kawasaki disease. Dr. Takahashi, who is the chairperson, said that Dr. Kawasaki's talking about Kawasaki disease looks like Beethoven's conducting his symphony by himself.
S-17 SymposiumFuture Issues on Genetic EpidemiologyFinding Genes that Influence Cardiovascular Disease by JamesE Hixon • CVD is caused by the interaction of many genes and environmental factors over an individual's lifetime. Strategies to find genes that influence CVD were showed as three steps. First step is genome-wide scans. Secondly, the scan identified many chromosomal regions that show linkage signal with length of 10-50cM. Linkage signal criteria : robust to new microsatelite marker, appropriate size of signal region, clustering related region, replication. Finding mapping as the third step is examined by the following aspects: biological candidate, expressional candidate. And each positional candidate gene will by surveyed using several single nucleotide polymorphism. Rochester Family Heart Study which is community-based and which subjects are 4486 individuals including 3 to 4 generations has yield linkage signal that will be followed to identify causative gene.
S-18 SymposiumUnited States Cardiovascular Health InitiativeFuture Directions for CVD Prevention ProgramsDR Labarthe • Future directions for CVD prevention program were presented. Four main frames were showed. They were national health goals for the US, a comprehensive framework of cardiovascular health, four key elements of the long-range strategic plan, and developing the long-range strategic plan. • National health goals for the US is presented by Healthy People 2010. There are two targets; the first is to increase quality and years of healthy life; the second is to eliminate health disparities. Goals for heart disease and stroke are prevention of risk factors and detection and treatment of risk factors. Goals of mortality from coronary heart disease and stroke are to reduce 20%, prevalence of high blood pressure to reduce 16%, and prevalence of high blood pressure to reduce 17%. • Four key elements of the Long-Range Strategic plan are 1:Taking action, 2:assessing impact, 3:strengthening activity, 4:advancing knowledge.
L-03 Special LectureCVD Mortality at the End of the 20th Century: Russian ParadoxRG Oganov (Russia) • In Russia CVD mortality rates increased gradually between 1965 and 1991, then they increased rapidly through 1994, followed by a rapid decrease from 1994 to 1998 and then increased again up to the 2000 year. These changes have been associated mainly, with psychosocial factors, but not with traditional CVD risk factors. Therefore, it is naive to expect essential improvement in public health until they have a rise in prosperity of the people. As Geoffrey Rose mentioned; "The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social." It is very true for the Russian today's situation.
L-04 Special LectureGlobal Strategies on Stroke PreventionR Bonita • Although mortality of stroke has been declined for past several decades, because of the ageing of many populations, projected numbers of stroke deaths will increase to year 2030, especially in developing countries. Thus, primary prevention of stroke is very important. There are two strategies for primary prevention. One is population strategy, and other is high-risk strategy. The benefit from population strategy is greater than high-risk strategy. For example, The Nurse Health Study showed about three quarters of all stroke in middle aged women could be prevented by risk factor modification only. • WHO strategy direction of stroke prevention is to reduce the burden of excess mortality and disability. And its priorities are as follows; strengthen global system, building national surveillance, training programs of surveillance, global net-work of surveillance.
L-05 Special LectureCentenarian and CVDMakoto Suzuki, CD Wilcox, BJ Willcox, Naha, JAPAN • Okinawa has the longest-lived population out of any country or state in the world according to the WHO and Japan Ministry of Health and Welfare (MHW). Okinawans seem to have delayed the aging process and the minimized debilitating diseases that accompany the elder years especially CVD, according to WHO and MHW data, three leading killers in the West, coronary heart disease, stroke and cancer, occur in Okinawa with among the lowest frequency in the world. • Generally, ventricular pump function is well compensated but heart failure can be triggered more and more easily with extreme ages. Much of the centenarians' long life expectancy can be attributed to minimization of CVD, especially through low cholesterol levels and minimal hypertension. Indeed it would be difficult to age successfully without some degree of protection against CVD.
L-06 Special LectureClinical trial for the prevention of CVDRM Grimm U.S.A • ALLHAT, practice-based randomized multi-center trial, aimed whether newer agents ( amlodipine, doxiazosin, and lisinopril ) reduce incidence of CHD compared to a diuretics. The 42,448 high risk hypertensives were allocated randomly to 4 agents groups. Primary endpoints of this trial were fatal and non-fatal CHD and secondary were all cause mortality, stroke, combined CHD etc. This trial started in 1994 and the doxazosin (alpha blocker) arm terminated because of significant difference for CHF at January 24, 2000. In doxazosin arm the relative risk for CHD and all cause mortality compared to chlorthalidone were 1.03 and 1.03 respectively but for CHF was 2.04 ( 1.79 - 2.32 ). One reason of this discrepancy was the difference of determination and comparison of severity of systolic dysfunction through ascertainment of ejection fraction. Additional comments about this issue were this trial did not investigated the effect of doxiazosin compared with placebo, and the findings were unlikely to apply to all alpha blocker.
F-13 059Relationship between Obesity and Cardiovascular Disease Mortalityamong Japanese Adults Based on the Result of NIPPON DATAI Oki, T Ojima, S Tanihara, Y Nakamura, K Sakata, H Yanagawa, A Okayama and H Uesima. For the NIPPON DATA80 Research Group, Japan • [Purpose] To examine whether obesity is an independent risk factor of cardiovascular disease (CVD) mortality among Japanese adults. • [Methods] Participants were 10,5113 men and women participated in 1980. Vital status has been ascertained in 9,748 (96%) subjects over 14-year follow-up period (NIPPON DATA). BMI was classified such as leanness, normal and obesity in accordance with the WHO classification. Cox's proportional hazard models was used . • [Results] Hazard ratios of leanness for CVD deaths were 1.22(0.84-1.78) in males and 1.60(1.08-2.36) in females, and 0.99(0.68-1.43) and 1.01(0.73-1.39) in obesity. • [Conclusion] Obesity is not an independent risk factor of CVD mortality among Japanese men and women.
F-14Methods and Implementation in CVD Epidemiology and Prevention (Newly Developed Devices and Indicators)O Tochikubo, PJ Schreiner, A Yamashina, T Mannami, L Sauvageau, and FS Leutenegger • Following Dr. Tochikubo's State of Art Lecture, in which he introduced 6 new devices for life-style modification. 5 papers were presented from 4 counties. In this session, possibilities of new parameters and methods for CVD prevention were discussed. Schreiner et al. (USA, 062) presented that lower bone mineral density (BMD) may be a marker of subclinical atherosclerosis in young men prior to development of either clinical cardiovascular disease or osteoporosis. Yamashita and colleagues (JPN, 063) suggested that brachial-ankle pulse wave velocity (PWV) is a valid and useful marker for early detection of arteriosclerosis. Mannami et al. (JPN, 064) showed that fibrinogen influenced carotid atherosclerosis. Sauvageau and colleagues (CAN, 065) showed the ability to develop and provide access to the low-cost specialized rehabilitation services. Leutenegger (SWI, 065) indicated that the training heart rate is a useful parameter of the risk of aerobic capacity, and of preventing cardiovascular disease among workers using industrial respirators. • All the presentations suggested the possibility of new installments to predict and prevent cardiovascular disease. Dr. Tochikubo
F-15 068 Hypertriglyceridemia and coronary artery diseaseMA Rahman, et al. • To see the association between hyperglyceridaemia and angiographically documented coronary artery diseases among Bangladeshi population. • Total 560 male adult patients who underwent coronary angiography were included. Fasting lipid profile was done prior to elective coronary angiography. Hypertriglyceridaemia is defined as following; TC>=200, TG>=200, or LDL-C:HDL-C ratio. • Mean age of all subjects is 52 years. Angiographically, 55 subjects were normal study (10.9%) and 505 were significant coronary artery diseases (90.1%). Frequencies of hyperglyceridaemia were 87% in the normal subjects and 74% in the CAD cases. • Hyperglyceridaemia is very common among Bangladeshi patients with CHD. • In discussion after the presentation, frequency of hyperglyceridaemia all over Bangladeshi was 45% in the national survey. Selection bias might exist in the study subjects, but hypertriglyceridaemia is really common in Bangladeshi.
F-23Methods and Implementation in CVD Epidemiology and Prevention (Assessment and Control of Risk Factors)I Shatz, TE Kottke, LA Wu, P Puska • For health-policy making, it is quite important to estimate the expected impact of the measure. In this session, one group from Minnesota (106 and 107) presented the estimated impact of a population-based coronary heart disease intervention under the assumption that whole population meets Healthy People 2010 goals for diabetes, smoking, blood pressure and cholesterol. According to their estimate, the coronary heart disease rate will be decreased by 44% in this scenario. They used the Framingham 10-year risk function in this estimates. The Honolulu Heart Program (105) shows an interesting U-shape relationship between CHD rate and total cholesterol level. The lowest CHD rates were seen in men with cholesterol levels between 200 and 219 mg/dl. This result indicates that we need to use the published risk function with caution for the estimates of health impact on population with different characteristics. The North Karelia Project (108) shows that well-planned, theory-based programme can be successfully implemented and a big impact on CVD rates.
T-093Relationship of serum uric acid and to blood pressure and cardiovascular risk factors in adolescentsMurata K, Tsujioka M, Hirose H, Kawabe H, Saito I, Saruta T • Authors discussed whether serum uric acid is associated with blood pressure and cardiovascular disease in adults. The subjects were 384 Japanese boys, 13 years of age, 707 boys, 17 years of age, and 147 boys, 22 years of age who underwent a routine examination in 1989, 1993, and 1998, respectively. The prevalence of hyperuricemia was 7.6%, 10.2%, and 10.9% at 13, 17, 22 years old, respectively. The persistence of serum uric acid was demonstrated by a correlation between childhood and adulthood levels. Baseline uric acid level was significant predictor of future hypertension. Exercise and alcohol drinking influence the serum uric acid. Hyperuricemia, hypertension, obesity, and blood lipid abnormality are closely interrelated. Moreover lifestyle such as exercise and alcohol intake influence the serum uric acid level. It is important to modify lifestyle from young age in order to prevent not only hyperuricemia but also hypertension.
A-2 Young Investigators' AwardImpact of Diet and Lifestyle on hypertension in 5 populations: Example of Fatty fish consumption in The US and FinlandJM Geleijnse, FJ Kok, and DE Grobbee • Authors analyzed 35 randomized trials of fish oil supplementation and BP in healthy adults from 1966 through 2001, in US, UK, Finland, Italy and the Netherlands. Meta-analyses of randomized BP trials are identified by MEDLINE. The population proportion with an unfavorable risk factor level is estimated from large nation-wide databases, and taken into account in the population attributable risks (PARs). • Intake of fish oil is inadequate (<0.3 % of energy) in 85% of US adults and 35% of Finish adults. PARs for hypertension (>140/90 mmHg) related to low intakes of fatty fish are 4-5% for US, and 1-2% for Finland. • Population strategies to increase the consumption of fatty fish is expected to have a large impact on the prevalence of hypertension in the USA than in Finland.
AnnouncementConcert Eveningwill be held Tonight, May 30 • Traditional Japanese Chorus of the Takarazuka, a famous entertainment group • Taiko ( Japanese drum ) performance • From 6:00 PM, at the Main Hall, Osaka International Convention Center • Tickets (\3,000) are available at the Registration Desk on the 3rd floor
Sightseeing Osaka -- Osaka Aquarium Kaiyukan Osaka has been blessed with an excellent harbor that helped it thrive since long ago. Today, as we enter the 21st century, the Bay area continues to be popular. Temposan Harbor Village, at the edge of the Minato-ku Ward, is the home of the Tempozan Market Place with many shops and restaurants. Next to the Market Place is the popular Kaiyukan aquarium, with a total of 39,000 marine animals, representing 580 species. Under the concepts of "Ring of Fire (The Pacific Rim Seismic and Volcanic Belt)" and "Ring of Life (The Pacific Rim Life Belt) ", Kaiyukan emphasizes the importance of respect for life and preservation of the natural environment. • Access to Tempozan Harbour Village: 5 min. walk from Osaka Bay Station, Subway Chuo Line or Technoport Line.