The impact of the metabolic syndrome and its components on the incidence of ischemic heart disease and stroke: the Japan public health center-based study
Open accessAbstract
In this study, we aimed to examine the impact of the metabolic syndrome and its components on the risk of cardiovascular disease among a relatively less-obese population. A total of 8249 men and 15 064 women, aged 40-69 years, with no history of ischemic heart disease, stroke and/or cancer completed a risk-factor survey between 1993 and 1995. The metabolic syndrome was defined based on modified criteria of the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF). Systematic cardiovascular surveillance was carried out throughout 2003, and 693 events of ischemic heart disease and stroke were identified. We observed significant associations of the metabolic syndrome with the risk of ischemic heart disease and ischemic stroke, but not with hemorrhagic stroke. The multivariable hazard ratio (95% confidence interval) of ischemic heart disease among men for the metabolic syndrome based on the AHA/NHLBI criteria was 2.25 (1.44-3.51) and that of ischemic stroke was 1.88 (1.40-2.52). The respective hazard ratios for the metabolic syndrome based on the IDF criteria were 1.61 (0.99-2.64) for ischemic heart disease and 1.94 (1.41-2.68) for ischemic stroke. The population-attributable fraction (PAF) of the metabolic syndrome based on the AHA/NHLBI criteria was higher than that based on the IDF criteria: 19 vs. 12% (P for difference=0.003) for ischemic cardiovascular disease among men, because non-overweight men with >or=2 risk factors were also at high risk (20% of the PAF). Our data suggest that the metabolic syndrome based on the AHA/NHLBI criteria predicts ischemic cardiovascular disease better than the syndrome based on the IDF criteria, because of the exclusion of non-overweight high-risk individuals from the reference group.
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Overlapping risk factors increase CAD incidence and mortality in the Japanese.
“Overlapping risk factors also increase the incidence and mortality rates of CAD in the Japanese45, 46).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [46]
The risk for CAD increases when HDL-C levels are less than 40 mg/dL.
“It has been revealed in regional and occupational cohort studies that the risk for CAD increases when HDL-C levels are < 40 mg/dL46, 53, 78, 79).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [46]
High TG is associated with CAD risk in Europe, the US, Asia, Oceania, and Japan.
“There have been numerous reports on the association between a high TG level and the risk for CAD not just in Europe and the US86), but also in Asia, Oceania87) and even in Japan46, 78, 88–91).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [46]
Women generally have higher HDL-C levels than men.
“Women generally have a higher HDL-C level than men46, 80, 85).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [46]
In Japanese epidemiological surveys, the occurrence of CAD increases when fasting TG levels are 150 mg/dL or higher.
“It has been shown in epidemiological surveys in Japan that the occurrence of CAD increases when fasting TG levels of are ≥ 150 mg/dL46, 90).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [46]
Many reports, including those from Japan, have stated that the lower the HDL-C level, the higher the incidence rate of cerebral infarction.
“There have been many reports, including those from Japan, stating that the lower the HDL-C level, the higher the incidence rate of cerebral infarction46, 859–861).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [46]
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- Authors
- for the JPHC Study Group, Noda, H., Iso, H., Saito, I., Konishi, M., Inoue, M., & Tsugane, S.
- Affiliations
- Harvard University (US)
- The University of Osaka (JP)
- Ehime University (JP)
- National Cancer Centre Japan (JP)
- Corresponding author
- Iso, Hiroyasu
- Venue
- Hypertension Research
- Published
- 2009-02-27
- Volume
- 32
- Issue
- 4
- Pages
- 289-298
- ISSN
- 0916-9636 (ISSN-L)
- 1348-4214
- OpenAlex
- W1999440604
- Cited by
- 116
- References
- 38
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 6 · 2018: 10 · 2017: 10 · 2016: 4 · 2015: 6 · 2014: 6 · 2013: 4 · 2012: 9
- FWCI
- 8.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Hypertension Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Uehara Memorial Foundation
- Tokyo University of Agriculture
- Tokyo Medical and Dental University
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- metabolic syndrome, ischemic heart disease, ischemic stroke, hemorrhagic stroke, cardiovascular risk factors, AHA/NHLBI criteria, IDF criteria, population attributable fraction, non-obese men
- MeSH terms
- Adult, Age Factors, Aged, Blood Glucose, Blood Pressure, Cardiovascular Diseases, Female, Health Surveys, Humans, Japan, Cholesterol, HDL, Male, Middle Aged, Prospective Studies, Sex Factors, Triglycerides, Cohort Studies, Proportional Hazards Models, Myocardial Ischemia, Stroke, Metabolic Syndrome, Overweight
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