title: Joint impact of smoking and hypertension on cardiovascular disease and all-cause mortality in Japan: NIPPON DATA80, a 19-year follow-up.
abstract: Hypertension and smoking are major risk factors for death due to cardiovascular disease (CVD). These attributions for CVD mortality should be higher in the countries where obesity-related conditions are uncommon. However, the joint effect of these risk factors on CVD and all-cause mortality have not been described. We followed a representative 8,912 Japanese men and women without a history of stroke and heart disease. Participants were categorized into 4 groups as follows: a group of individuals who neither smoked nor had hypertension (HT), a group of current smokers, a group with HT, and a group of current smokers with HT. We further calculated population-attributable fractions (PAF) of CVD and all-cause mortality based on relative hazards assessed by proportional hazard regression models. After 19 years of follow-up, we observed 313 and 291 CVD and 948 and 766 all-cause deaths for men and women, respectively. The PAF of CVD mortality due to smoking or HT were 35.1% for men and 22.1% for women. The PAF of CVD mortality was higher in participants <60 years of age (57.4% for men and 40.7% for women) vs. those who were older (26.3% for men and 18.1% for women). Aggressive attempts to discourage smoking and to curb HT could yield large health benefits in Japan and throughout Asia, particularly for those aged <60 years. Efforts to warn about the adverse consequence of HT and smoking during adolescence and youth could yield the greatest health benefits, since positive behaviors adopted early are more easily continued into middle adulthood and later life.
authors.affiliation: Department of Health Science, Shiga University of Medical Science, Otsu, Japan. ahozawa@belle.shiga-med.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Murakami
authors.forename: Takashi
authors.initials: T
authors.lastname: Kadowaki
authors.forename: Koshi
authors.initials: K
authors.lastname: Nakamura
authors.forename: Takehito
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Kita
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Robert D
authors.initials: RD
authors.lastname: Abbott
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*