Akira Fujiyoshi

Introduction: Most studies have examined ‘perceived harm of heated tobacco products (HTPs)’ relative to combustible cigarettes (CCs). However, there is a lack of understanding regarding whether the public perceives HTPs as harmful in an absolute sense and whether this perception varies according to smoking status. Therefore, we examined the perceived absolute harm of HTPs (not relative to CCs) across different smoking statuses. Methods: We surveyed 8229 respondents (3292 females) online in Japan in 2020. Analyses were stratified by sex because of corresponding differences in smoking rates in Japan. Logistic regression was performed to calculate the ORs, adjusted for potential confounders, including age and education, of agreeing with the statements ‘ HTP does little harm to self’ and ‘ HTP does no harm to others’ among current smokers (CC-only, HTP-only and dual users) in reference to current non-smokers. Results: Current male smokers, particularly HTP users, were more likely to agree with ‘ little harm to self’ than current non-smokers: ORs (95% CI, 1.64 (1.27 to 2.12), 3.08 (2.25 to 4.20) and 4.78 (3.82 to 5.97) in CC-only, HTP-only and dual users, respectively. The corresponding ORs of agreeing with ‘ no harm to others’ in male smokers were 1.95 (1.58 to 2.42), 5.40 (4.15 to 7.01) and 4.78 (3.90 to 5.85). The results for females were qualitatively similar to those of males. Conclusions: Regardless of sexes, current smokers, particularly HTP users, tended to perceive HTP to do little harm to themselves and no harm to others in an absolute sense than current non-smokers. Providing accurate and up-to-date health information regarding HTP is crucial in minimising potential health risks to both smokers and non-smokers.

Introduction: Intracranial subclinical vessel diseases are considered important indicators of cognitive impairment. However, a comprehensive assessment of various types of vessel disease, particularly in Asian populations, is lacking. We aimed to compare multiple types of intracranial vessel disease in association with cognitive function among a community-based Japanese male population. Methods: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) randomly recruited and examined a community-based cohort of Japanese men from Shiga, Japan. We analyzed those who underwent the Cognitive Abilities Screening Instrument (CASI) assessment and cranial magnetic resonance imaging/angiogram (MRI/MRA) in 2010–2015. Using MRI/MRA, we assessed lacunar infarction, microbleeds, periventricular hyperintensity (PVH), deep subcortical white matter hyperintensity (DSWMH), and intracranial artery stenosis (ICAS). We divided these subclinical cerebrovascular diseases (SCDs) into three categories according to severity. Using linear regression, we calculated the CASI score according to the grade of each vessel disease, adjusted for age and years of education. Results: In the adjusted models, CASI scores were significantly associated with both PVH and DSWMH. Specifically, multivariable-adjusted CASI scores declined across increasing severity categories of DSWMH (91.7, 91.2, and 90.4; p for trend = 0.011) and PVH (91.5, 90.4, and 89.7; p for trend = 0.006). Other SCDs did not show significant associations. In stratified analyses based on the presence or absence of each SCD, both DSWMH and PVH demonstrated significant inverse trends with CASI scores in the absence of lacunar infarcts and microbleeds and in the presence of ICAS. Additionally, among participants with PVH (+), ≥moderate ICAS was significantly associated with lower CASI scores. Conclusion: PVH and DSWMH showed significant dose-response relationships with cognitive function among community-based Japanese men. These findings suggest that white matter lesions may be an important indicator of early cognitive impairment, and severe ICAS may also play a role in those with PVH.

Background: The aim of this study was to clarify the association between serum total cholesterol and fatal subarachnoid hemorrhage in Japanese men and women. Methods: The study involved a pooled analysis of data from 12 well-qualified cohort studies conducted in Japan. A total of 120,973 participants (70,947 women and 50,026 men) aged 18– 96 years at baseline underwent follow-up for a median of 12.7 years. The participants were classified according to their serum total cholesterol levels: <4.14 mmol/L (<160 mg/dL), 4.14–4.64 mmol/L (160–180 mg/dL), 4.65–5.16 mmol/L (180–199 mg/dL), 5.17–5.68 mmol/L (200–219 mg/dL), 5.69–6.20 mmol/L (220–239 mg/dL), and ≥6.21 mmol/L (≥240 mg/dL). The outcome of the analysis was death from subarachnoid hemorrhage. Results: During the median follow-up of 12.7 years, 261 participants died from subarachnoid hemorrhage. In women, both low (<5.69 mmol/L [<220 mg/dL]) and high (≥6.21 mmol/L [≥240 mg/dL]) serum total cholesterol levels were significantly associated with a higher risk of fatal subarachnoid hemorrhage compared with the reference group (5.69–6.20 mmol/L [220–239 mg/dL]). These associations remained significant after adjustment for confounding factors. In contrast, no associations were observed in men. Conclusions: Both low and high serum total cholesterol levels were associated with a higher risk of fatal subarachnoid hemorrhage in 70,947 female participants from 12 cohort studies throughout Japan.

Background: Carotid intima‐media thickness (cIMT) has been widely used as a predictor of future cardiovascular disease (CVD); however, various definitions of cIMT exist. This study provides a systematic review and meta‐analysis of the associations between different cIMT definitions and CVD. Methods and results: A systematic review of the different cIMT definitions used in prospective cohort studies was performed. The relationships between cIMT of different definitions (common carotid artery IMT [CCA‐IMT], internal carotid artery IMT [ICA‐IMT], combined segments [combined‐IMT], mean CCA‐IMT, and maximum CCA‐IMT) with future stroke, myocardial infarction (MI), and CVD events were analyzed using random effects models. Among 2287 articles, 18 articles (14 studies) with >10 different cIMT definitions were identified and included in our meta‐analysis. After adjusting for age and sex, a 1‐SD increase in CCA‐IMT was associated with future stroke (hazard ratio [HR], 1.32 [95% CI, 1.27–1.38]), MI (HR, 1.27 [95% CI, 1.22–1.33]), and CVD events (HR, 1.28 [95% CI, 1.19–1.37]). A 1‐SD increase in ICA‐IMT was related to future stroke (HR, 1.25 [95% CI, 1.11–1.42]) and CVD events (HR, 1.25 [95% CI, 1.04–1.50]) but not MI (HR, 1.26 [95% CI, 0.98–1.61]). A 1‐SD increase in combined‐IMT was associated with future stroke (HR, 1.30 [95% CI, 1.08–1.57]) and CVD events (HR, 1.36 [95% CI, 1.23–1.49]). Maximum CCA‐IMT was more strongly related than mean CCA‐IMT with risk of MI, and both measures were similarly associated with stroke and CVD events. Conclusions: Combined‐IMT is more strongly associated with CVD events compared with single‐segment cIMT definitions. Maximum CCA‐IMT shows a stronger association with MI than mean CCA‐IMT. Further research is warranted to validate our findings and to standardize the cIMT measurement protocol, as well as to explore underlying mechanisms.

Aims: Low muscle mass is associated with advanced atherosclerosis. However, only very few studies on the elderly have investigated a dose-response relationship between muscle mass and atherosclerosis. Furthermore, whether the relationship between muscle mass and atherosclerosis is stronger than that between body mass index (BMI) and atherosclerosis among the elderly population remains to be determined. Methods: A community-based sample of apparently healthy elderlies (≥ 65 years) was cross-sectionally examined for the association between appendicular skeletal muscle mass (ASM) and br achial-ankle pulse wave velocity (baPWV), a measure of atherosclerosis. We categorized the participants according to sex-specific quintiles of the ASM index (ASM/height ² ) or BMI. Using multivariable linear regression, we compared the slope of one standard deviation higher ASM index for baPWV with the corresponding slope of BMI, separately (single-index model) and jointly (simultaneously-adjusted model). Results: The ASM index and BMI of a total of 995 participants (60.0% women, mean age 73 years) were significantly inversely associated with baPWV in a dose-response manner across the quintiles in both sexes. The slope for the ASM index tended to be greater than that for BMI in the single-index and simultaneously-adjusted models in both sexes after adjusting for confounders. Conclusions: Among a community-dwelling elderly population, the association between ASM and baPWV was stronger than, and independent of that between BMI and baPWV. These findings suggest that ASM provides more important information on atherosclerosis in the elderly than BMI does.

Background: Little is known regarding whether arterial stiffness and atherosclerotic burden are each independently associated with brain structural changes. Simultaneous assessments of both arterial stiffness and atherosclerotic burden in associations with brain could provide insights into the mechanisms of brain structural changes. Methods and Results: Using data from the SESSA (Shiga Epidemiological Study of Subclinical Atherosclerosis), we analyzed data among 686 Japanese men (mean [SD] age, 67.9 [8.4] years; range, 46–83 years) free from history of stroke and myocardial infarction. Brachial‐ankle pulse wave velocity and coronary artery calcification on computed tomography scans were measured between March 2010 and August 2014. Brain volumes (total brain volume, gray matter, Alzheimer disease signature and prefrontal) and brain vascular damage (white matter hyperintensities) were quantified using brain magnetic resonance imaging from January 2012 through February 2015. In multivariable adjustment models including mean arterial pressure, when brachial‐ankle pulse wave velocity and coronary artery calcification were entered into the same models, the β (95% CI) for Alzheimer disease signature volume for each 1‐SD increase in brachial‐ankle pulse wave velocity was −0.33 (−0.64 to −0.02), and the unstandardized β (95% CI) for white matter hyperintensities for each 1‐unit increase in coronary artery calcification was 0.68 (0.05–1.32). Brachial‐ankle pulse wave velocity and coronary artery calcification were not statistically significantly associated with total brain and gray matter volumes. Conclusions: Among Japanese men, higher arterial stiffness was associated with lower Alzheimer disease signature volumes, whereas higher atherosclerotic burden was associated with brain vascular damage. Arterial stiffness and atherosclerotic burden may be independently associated with brain structural changes via different pathways.

Background: Basic and instrumental activities of daily living (BADL, IADL) are known predictors of mortality. However, the relationship between higher-level functional capacity (HLFC) and mortality and related sex differences have rarely been investigated.Methods: A prospective population-based cohort study was conducted in 1,824 older residents (≥65 years) with independent BADL from 300 randomly selected areas in Japan from 1995, and the participants were followed up until 2010. Using the Cox proportional hazards model, the relationship between HLFC and mortality risk was investigated with adjustment for possible confounders. HLFC was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Baseline data were collected using a questionnaire or by home-visit interviews.Results: During an average 12.2-year follow-up, all-cause death was observed in 836 (45.8%) participants. Impaired HLFC was significantly associated with mortality (hazard ratio [HR] 1.37; 95% confidence interval [CI], 1.13–1.65). Lower social role was significantly associated with higher mortality risk in men (HR 1.38; 95% CI, 1.13–1.68). Lower IADL and intellectual activity were significantly associated with higher mortality risk in women (HR 1.50; 95% CI, 1.15–1.95; HR 1.46; 95% CI, 1.19–1.79). The relationship between HLFC and mortality risk showed a similar tendency among cardiovascular diseases, stroke, cancer, and pneumonia.Conclusion: Impaired HLFC was associated with a high risk of all-cause mortality among community-dwelling older people with independent BADL. In particular, social role in men and IADL and intellectual activity in women were associated with long-term mortality risk.