Blood pressure, low-density lipoprotein cholesterol, and incidences of coronary artery disease and ischemic stroke in Japanese: the Suita study.
BACKGROUND
Blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) are risk factors for coronary artery disease (CAD) and ischemic stroke. However, the hazards of their coexistence are not fully understood in Asian populations. We investigated whether the relationship between BP and cardiovascular disease (CVD) outcomes are modified by LDL-C level in a Japanese population.


METHODS
Individuals aged 30-79 years (n = 5,151) were classified into 6 groups according to LDL-C levels (<140 and ≥140mg/dL or lipid medication) and BP levels (optimal BP, prehypertension, and hypertension; reference: low LDL-C and optimal BP). Hazard ratios (HRs) were calculated after adjusting for age, high-density lipoprotein cholesterol, diabetes, smoking status, and alcohol consumption. The effect modification of LDL-C on BP-CVD association was assessed using likelihood ratio tests.


RESULTS
There were 264 CAD and 215 ischemic stroke events during 13 years of follow-up. With low LDL-C, the HRs of prehypertension and hypertension for CAD were 2.01 and 4.71, respectively. Similar trends of HRs were observed with high LDL-C (optimal BP = 2.09, prehypertension = 3.45, hypertension = 5.94). However, the HRs for ischemic stroke did not differ between normal and high LDL-C levels at the same BP level. The apparent effect modification of LDL-C was not observed in the BP-CVD association in either CAD (P = 0.48) or ischemic stroke (P = 0.39).


CONCLUSIONS
The HRs for CAD in prehypertensive and hypertensive groups were higher than those in the optimal BP group at the same LDL-C levels in a Japanese population; however, there was no statistical effect modification of LDL-C on the BP-CAD association.
Department of Public Health Nursing, Osaka Medical College, Takatsuki, Osaka, Japan; rumitsukinoki@gmail.com.
Rumi
R
Tsukinoki
Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan;
Tomonori
T
Okamura
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan;
Makoto
M
Watanabe
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan;
Yoshihiro
Y
Kokubo
Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan;
Aya
A
Higashiyama
Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan;
Kunihiro
K
Nishimura
Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan;
Misa
M
Takegami
Department of Medical Statistics, Shiga University of Medical Science, Otsu, Shiga, Japan;
Yoshitaka
Y
Murakami
First Institute of Health Service, Japan Anti-Tuberculosis Association, Tokyo, Japan.
Akira
A
Okayama
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan;
Yoshihiro
Y
Miyamoto
D000328:Adult; D000368:Aged; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008019:Life Style / Q000208:ethnology; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058246:Prehypertension / Q000208:ethnology / Q000503:physiopathology; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D013997:Time Factors
D015415:Biomarkers; D008078:Cholesterol, LDL
Asian; Suita Study.; blood pressure; cohort study; coronary artery disease; hypertension; incidence; ischemic stroke; low-density lipoprotein cholesterol