title: Diabetes and the risk of coronary heart disease in the general Japanese population: the Japan Public Health Center-based prospective (JPHC) study.
abstract: OBJECTIVE
  Although diabetes has a great impact on coronary heart disease (CHD) in Western populations, there is limited evidence that diabetes influences CHD in the Japanese population.
  
  
  METHODS
  The Japan Public Health Center-based prospective (JPHC) study conducted a follow-up of 31,192 individuals aged 40-69 years with no history of cardiovascular disease or cancer. Subjects were classified at baseline as normal, borderline diabetic or diabetic based on fasting and non-fasting blood glucose levels and the use of medication to treat diabetes. A Cox proportional hazards model was used to determine the association between diabetes and the risk of fatal and non-fatal CHD events after adjustment for potential confounders.
  
  
  RESULTS
  During 12.9 years of follow-up (1990-2006), we identified 266 fatal and non-fatal coronary events using validated criteria. With normal individuals serving as a control, the hazard ratios for total incident CHD events after adjusting for sex, age, study community and fasting were 1.65 (95% CI, 1.19-2.29) and 3.05 (2.03-4.59) in the borderline and diabetic groups, respectively. These associations remained significant after adjustment for conventional risk factors. The population attributable fractions (PAF) of borderline diabetes and diabetes for CHD events were 6.9% and 6.3%, respectively. Furthermore, there was a trend for an association between an impaired fasting glucose (5.6-6.9 mmol/l) and an increased risk of CHD events.
  
  
  CONCLUSIONS
  This prospective study suggests that diabetes and elevated glucose levels are associated with incident CHD in the general Japanese population. The PAF of diabetes for fatal and non-fatal coronary events was estimated to be moderate.
authors.affiliation: Department of Public Health, Social Medicine and Medical Informatics, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime 791-0295, Japan. saitoi@m.ehime-u.ac.jp
authors.forename: Isao
authors.initials: I
authors.lastname: Saito
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kokubo
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.forename: Manami
authors.initials: M
authors.lastname: Inoue
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D001786:Blood Glucose / Q000378:metabolism; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000208:ethnology* / Q000401:mortality; D048909:Diabetes Complications / Q000208:ethnology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents