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Cited by 813Lipoproteins and Cardiovascular HealthHealth Promotion and Cardiovascular PreventionDiabetes, Cardiovascular Risks, and Lipoproteins

Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017

Open access
Kinoshita, Makoto, Yokote, Koutaro, Arai, Hidenori, Iida, Mami, Ishigaki, Yasushi, Ishibashi, Shun, Umemoto, Seiji, Egusa, Genshi +25 more·2018·Journal of Atherosclerosis and Thrombosis
DOI 10.5551/jat.gl2017PMC PMC6143773
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Abstract

Chapter 1. Summary of the Guidelines… …………………………………………………………………………………… Chapter 2. Clinical Diagnosis of Atherosclerosis… ……………………………………………………………………… Chapter 3. Comprehensive Risk Assessment… …………………………………………………………………………… 3-1.Risk Factor Assessment… …………………………………………………………………………………………… 3-2.Disease Concept and Diagnostic Criteria for Metabolic Syndrome… ………………………………………… Chapter 4. Comprehensive Risk Management… ………………………………………………………………………… 4-1.Absolute Risk of Atherosclerotic Cardiovascular Diseases (ASCVD) and Lipid-Management Targets…… 4-2.…LifestyleModification… ……………………………………………………………………………………………… 4-3.Drug Therapy… ……………………………………………………………………………………………………… 4-4.Managing Major High-Risk Conditions…………………………………………………………………………… 4-5.Implementation of Comprehensive Risk Assessment and Management… …………………………………… Chapter 5. Familial Hypercholesterolemia… ……………………………………………………………………………… Chapter 6.Other Types of Primary Dyslipidemias… …………………………………………………………………… Chapter 7. Elderly… ………………………………………………………………………………………………………… Chapter 8. Women… ………………………………………………………………………………………………………… Chapter 9. Children… …………………………………………………………………………………………………………

AI snapshot

Written from a shortened version of the paper’s full text (it is longer than we read).

TL;DR

The Japan Atherosclerosis Society's 2017 guidelines update its recommendations for preventing atherosclerotic cardiovascular disease (ASCVD), shifting absolute-risk estimation from the NIPPON DATA80 chart to the Suita score and adding systematic-review-based Clinical Questions. It sets LDL-C management targets by risk category and recommends stricter targets (<70 mg/dL) for high-risk secondary prevention such as familial hypercholesterolemia and acute coronary syndrome.

Key findings

  • Diagnostic criteria for dyslipidemia: LDL-C ≥140 mg/dL (borderline 120–139), HDL-C <40 mg/dL, TG ≥150 mg/dL, non-HDL-C ≥170 mg/dL (borderline 150–169).
  • LDL-C management targets: <160 mg/dL (low risk), <140 mg/dL (moderate), <120 mg/dL (high), <100 mg/dL (secondary prevention; or ≥50% reduction if <100 is unachievable), and <70 mg/dL for secondary prevention complicated by FH or ACS.
  • Absolute risk is stratified by the Suita score: ≤40 low (10-year CAD incidence <2%), 41–55 moderate (2–8%), ≥56 high (≥9%); a simplified risk-factor flowchart is provided as an alternative.
  • Smoking relative risks from Japanese meta-analyses: CAD incidence/death 2.15× (≤20 cigarettes/day) and 3.28× (>20); stroke 1.41× and 1.56×; AAA 3.89× (men) and 4.30× (women). Passive smoking: CAD 1.31×, stroke 1.25×.
  • Diabetes: Hisayama study CAD incidence 5.0 vs 1.6 per 1,000 person-years (diabetic vs normal glucose tolerance); cerebral infarction 6.5 vs 1.9 per 1,000 person-years. FH heterozygotes estimated at 1 in 200–500.
  • Statins are first-line for LDL-C lowering; ezetimibe, PCSK9 inhibitors, and EPA are cited as effective in combination with statins.

Methods

  • Guideline revision by a JAS committee, with Clinical Questions and systematic reviews conducted using the MINDS method, generally covering literature published before the end of 2015.
  • Evidence levels (1+ to 4 for treatment/diagnosis; E-Ⅰa to E-Ⅲ for epidemiological studies) and recommendation levels (A strong, B weak) were assigned; consensus-based recommendations are labeled "consensus."
  • For absolute risk, nine Japanese cohort risk-assessment tools were reviewed and the Suita study was selected because it included both LDL-C and HDL-C, detailed LDL-C categories, CAD (not stroke) as the endpoint, and disease onset rather than death as the outcome.

Limitations

  • Stated: NIPPON DATA80 (used in the 2012 version) used death rather than disease onset as the outcome, lacked LDL-C and HDL-C information, and its 1980 baseline overestimates mortality in recent populations.
  • Stated: the Suita score's estimated absolute CAD risk may be higher than in other regional Japanese cohorts because the Suita study has a higher CAD incidence and includes coronary intervention as an outcome; risk-category thresholds were based on clinical consensus and social conventions rather than statistical derivation.
  • Stated: no Japanese, US, or European risk scores account for whether patients are taking lipid- or glucose-lowering medication, so predicted risk may underestimate actual risk in treated patients; evidence for non-invasive arterial-wall indices (other than ABI) leading to stricter management is still insufficient.
  • Evident in the text: the committee disclosed extensive industry conflicts of interest (a list of companies, applicable period January 2013–December 2015).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.5551/jat.gl2017

Cites

967 of 967 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 890 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    A high CAVI value is associated with a high frequency of cardiovascular events.

    “Prospective surveys on cardiovascular events have revealed that a high CAVI value is associated with a high frequency of cardiovascular events30).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] 30) Sato Y, Nagayama D, Saiki A, Watanabe R, Watanabe Y, Imamura H, Yamaguchi T, Ban N, Kawana H, Nagumo A, Ohira M, Endo K, Kurosu T, Tomaru T, Shirai K, Tatsuno I. Cardio-ankle vascular index is independently associated with future cardiovascular events in outpatients with metabolic disorders. J Atheroscler Thromb, 2016; 23: 596-605 source

      Not checked in the free run.

  • Findingcitation

    Patients with cerebral infarction, CVD, CKD, and vasculitis have high CAVI values.

    “The CAVI increases with age28), and patients with cerebral infarction, CVD29), chronic kidney disease (CKD), and vasculitis have high CAVI values.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] 29) Takenaka T, Hoshi H, Kato N, Kobayashi K, Takane H, Shoda J, Suzuki H. Cardio-ankle vascular index to screen cardiovascular diseases in patients with end-stage renal diseases. J Atheroscler Thromb, 2008; 15: 339-344 source

      Not checked in the free run.

  • Findingcitation

    CAVI increases with age.

    “The CAVI increases with age28), and patients with cerebral infarction, CVD29), chronic kidney disease (CKD), and vasculitis have high CAVI values.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] 28) Shirai K, Hiruta N, Song M, Kurosu T, Suzuki J, Tomaru T, Miyashita Y, Saiki A, Takahashi M, Suzuki K, Takata M. Cardio-ankle vascular index (CAVI) as a novel indicator of arterial stiffness: Theory, evidence and perspectives. J Atheroscler Thromb, 2011; 18: 924-938 source

      Not checked in the free run.

  • Findingcitation

    Adding IMT measurement does not increase the ability of the Framingham Risk Score to predict risk.

    “reports of other countries have revealed that adding the result of IMT measurement does not increase the ability of risk prediction by the Framingham Risk Score33).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] 33) Den Ruijter HM, Peters SA, Anderson TJ, Britton AR, Dekker JM, Eijkemans MJ, Engstrom G, Evans GW, de Graaf J, Grobbee DE, Hedblad B, Hofman A, Holewijn S, Ikeda A, Kavousi M, Kitagawa K, Kitamura A, Koffijberg H, Lonn EM, Lorenz MW, Mathiesen EB, Nijpels G, Okazaki S, O’Leary DH, Polak JF, Price JF, Robertson C, Rembold CM, Rosvall M, Rundek T, Salonen JT, Sitzer M, Stehouwer CD, Witteman JC, Moons KG, Bots ML. Common carotid intima-media thickness measurements in cardiovascular risk prediction: A metaanalysis. JAMA, 2012; 308: 796-803 source

      Not checked in the free run.

  • Findingown data

    Categorization based on Fig. 2 and that based on Fig. 1 have been verified through simulation and found to be almost consistent.

    “Categorization based on Fig. 2 and that based on Fig. 1 have been verified through simulation and found to be almost consistent.”
    Quote in the paperSubstantial claim
  • May combine two claims. 176
  • Classified as probably not a substantial claim. 68
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingcitation

    CAVI is increased in patients with hypertension, diabetes, metabolic syndrome, sleep apnea syndrome, smoking, or disaster stress, and improves with treatment of these contributing factors.

    “It is also increased in patients who suffer from hypertension, diabetes, metabolic syndromes, sleep apnea syndrome (SAS), smoking, stress caused by disasters, etc., but at the same time, it has been reported that the CAVI improves with treatment of these contributing factors25).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] 25) Saiki A, Sato Y, Watanabe R, Watanabe Y, Imamura H, Yamaguchi T, Ban N, Kawana H, Nagumo A, Nagayama D, Ohira M, Endo K, Tatsuno I. The role of a novel arterial stiffness parameter, cardio-ankle vascular index (CAVI), as a surrogate marker for cardiovascular diseases. J Atheroscler Thromb, 2016; 23: 155-168 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In CIRCS, compared with LDL-C less than 80 mg/dL, CAD risk increased 1.4 times in the 80-99 mg/dL group, 1.7 times in the 100-119 mg/dL group, 2.2 times in the 120-139 mg/dL group, and 2.8 times in the 140 mg/dL or higher group.

    “in comparison with the LDL-C < 80 mg/dL group, the risk was increased by 1.4 times in the 80–99 mg/dL group, 1.7 times in the 100–119 mg/dL group, 2.2 times in the 120–139 mg/dL group, and 2.8 times in the ≥ 140 mg/dL group37).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] 37) Imano H, Noda H, Kitamura A, Sato S, Kiyama M, Sankai T, Ohira T, Nakamura M, Yamagishi K, Ikeda A, Shimamoto T, Iso H. Low-density lipoprotein cholesterol and risk of coronary heart disease among Japanese men and women: The Circulatory Risk in Communities Study (CIRCS). Prev Med, 2011; 52: 381-386 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    When TC was 240 mg/dL or higher, the hazard ratio increased to 1.79 times but the population attributable fraction dropped to 11.9%.

    “When the TC level was ≥ 240 mg/dL, even though the hazard ratio further increased to 1.79 times, the PAF dropped to 11.9%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    LDL-C is positively related to cerebral infarction and negatively related to hemorrhagic stroke.

    “Among the types of stroke, LDL-C has been shown to be positively related to cerebral infarction and negatively related to hemorrhagic stroke”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In NIPPON DATA80, the hazard ratio for CAD death was 1.55 times higher in the TC 220 mg/dL or higher group than in the TC less than 220 mg/dL group, with a population attributable fraction of 18.2%.

    “A 24-year follow-up in NIPPON DATA80 showed that the hazard ratio for CAD death was 1.55 times higher in the TC ≥ 220 mg/dL group than in the TC < 220 mg/dL group, and the population attributable fraction (PAF) was 18.2%54).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] 54) Sugiyama D, Okamura T, Watanabe M, Higashiyama A, Okuda N, Nakamura Y, Hozawa A, Kita Y, Kadota A, Murakami Y, Miyamatsu N, Ohkubo T, Hayakawa T, Miyamoto Y, Miura K, Okayama A, Ueshima H. Risk of hypercholesterolemia for cardiovascular disease and the population attributable fraction in a 24-year Japanese cohort study. J Atheroscler Thromb, 2015; 22: 95-107 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    TC is positively related to cerebral infarction and negatively related to hemorrhagic stroke.

    “Regarding stroke, it has been shown that TC is positively related to cerebral infarction and negatively related to hemorrhagic stroke, a result that many studies have in common.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Elevated LDL-C predicts future CAD incidence and mortality.

    “Elevated LDL-C predicts the CAD incidence and mortality in the future.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The association between TC and CAD incidence/mortality is almost linear, with a statistically significant increase in risk around 220 mg/dL in many studies.

    “The association between TC and the incidence/mortality rate of CAD is almost linear, but a statistically significant increase in risk with TC levels around 220 mg/dL has been observed in many studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The relationship between TC and CAD death was seen in both men and women, but some reports state it is attenuated in individuals aged 65 years or older.

    “Although a relationship between TC and risk of CAD death was seen in both the men and women, some reports have stated that this relation is attenuated in elderly individuals who are ≥ 65 years old55).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] 55) Nagasawa SY, Okamura T, Iso H, Tamakoshi A, Yamada M, Watanabe M, Murakami Y, Miura K, Ueshima H. Relation between serum total cholesterol level and cardiovascular disease stratified by sex and age group: A pooled analysis of 65 594 individuals from 10 cohort studies in Japan. J Am Heart Assoc, 2012; 1: e001974 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Some reports say the non-HDL-C-stroke association is unclear, and others show increased risk when non-HDL-C levels are low.

    “There are reports saying that the association is unclear51, 67), and there are also those that revealed an increase in risk when non-HDL-C levels were low70).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [51] 51) Tanabe N, Iso H, Okada K, Nakamura Y, Harada A, Ohashi Y, Ando T, Ueshima H, Japan Arteriosclerosis L. Serum total and non-high-density lipoprotein cholesterol and the risk prediction of cardiovascular events - the JALS-ECC. Circ J, 2010; 74: 1346-1356 source

      Not checked in the free run.

    • cites [67] 67) Imamura T, Doi Y, Ninomiya T, Hata J, Nagata M, Ikeda F, Mukai N, Hirakawa Y, Yoshida D, Fukuhara M, Kitazono T, Kiyohara Y. Non-high-density lipoprotein cholesterol and the development of coronary heart disease and stroke subtypes in a general Japanese population: The Hisayama study. Atherosclerosis, 2014; 233: 343-348 source

      Not checked in the free run.

    • cites [70] 71) Kitamura A, Noda H, Nakamura M, Kiyama M, Okada T, Imano H, Ohira T, Sato S, Yamagishi K, Iso H. Association between non-high-density lipoprotein cholesterol levels and the incidence of coronary heart disease among Japanese: The Circulatory Risk in Communities Study (CIRCS). J Atheroscler Thromb, 2011; 18: 454-463 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The risk of onset and death increased when non-HDL-C levels were 170-180 mg/dL or more, but no fixed trend was observed in women.

    “In all of these studies, the risk of onset and risk of death were evidently increased when non-HDL-C levels were ≥ 170–180 mg/dL or more, but there was no fixed trend observed in the women51, 64, 71, 73).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [51] 51) Tanabe N, Iso H, Okada K, Nakamura Y, Harada A, Ohashi Y, Ando T, Ueshima H, Japan Arteriosclerosis L. Serum total and non-high-density lipoprotein cholesterol and the risk prediction of cardiovascular events - the JALS-ECC. Circ J, 2010; 74: 1346-1356 source

      Not checked in the free run.

    • cites [64] 64) Okamura T, Kokubo Y, Watanabe M, Higashiyama A, Miyamoto Y, Yoshimasa Y, Okayama A. Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol and the incidence of cardiovascular disease in an urban Japanese cohort study: The Suita study. Atherosclerosis, 2009; 203: 587-592 source

      Not checked in the free run.

    • cites [71] 72) Tanaka F, Makita S, Onoda T, Tanno K, Ohsawa M, Itai K, Sakata K, Omama S, Yoshida Y, Ogasawara K, Ogawa A, Ishibashi Y, Kuribayashi T, Okayama A, Nakamura M. Predictive value of lipoprotein indices for residual risk of acute myocardial infarction and sudden death in men with low-density lipoprotein cholesterol levels &lt;120 mg/dl. Am J Cardiol, 2013; 112: 1063-1068 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Low HDL-C is a risk for developing CAD and ischemic stroke, and high HDL-C decreases risk.

    “A low HDL-C level is a risk for developing CAD and ischemic stroke. On the contrary, the risk decreases when HDL-C levels are high39, 53, 76–79).”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [39] 39) Yokokawa H, Yasumura S, Tanno K, Ohsawa M, Onoda T, Itai K, Sakata K, Kawamura K, Tanaka F, Yoshida Y, Nakamura M, Terayama Y, Ogawa A, Okayama A. Serum low-density lipoprotein to high-density lipoprotein ratio as a predictor of future acute myocardial infarction among men in a 2.7-year cohort study of a Japanese northern rural population. J Atheroscler Thromb, 2011; 18: 89-98 source

      Not checked in the free run.

    • cites [53] 53) Kitamura A, Iso H, Naito Y, Iida M, Konishi M, Folsom AR, Sato S, Kiyama M, Nakamura M, Sankai T, Shimamoto T, Komachi Y. High-density lipoprotein cholesterol and premature coronary heart disease in urban Japanese men. Circulation, 1994; 89: 2533-2539 source

      Not checked in the free run.

    • cites [76] 77) Soyama Y, Miura K, Morikawa Y, Nishijo M, Nakanishi Y, Naruse Y, Kagamimori S, Nakagawa H. High-density lipoprotein cholesterol and risk of stroke in Japanese men and women: The Oyabe Study. Stroke, 2003; 34: 863-868 source

      Not checked in the free run.

    • cites [77] 78) Iso H, Sato S, Kitamura A, Imano H, Kiyama M, Yamagishi K, Cui R, Tanigawa T, Shimamoto T. Metabolic syndrome and the risk of ischemic heart disease and stroke among Japanese men and women. Stroke, 2007; 38: 1744-1751 source

      Not checked in the free run.

    • cites [78] 79) Satoh H, Tomita K, Fujii S, Kishi R, Tsutsui H. Lower high-density lipoprotein cholesterol is a significant and independent risk for coronary artery disease in Japanese men. J Atheroscler Thromb, 2009; 16: 792-798 source

      Not checked in the free run.

    • cites [79] 80) Okamura T, Hayakawa T, Kadowaki T, Kita Y, Okayama A, Ueshima H, NIPPON DATA90 Research Group. The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population. Atherosclerosis, 2006; 184: 143-150 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    There are reports stating that no association exists between non-HDL-C and stroke.

    “But at the same time, there are reports stating that an association does not exist in regard to stroke.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Compared with nonsmokers, smokers have a higher risk for CAD and stroke, with a dose-response relationship.

    “Compared to nonsmokers, smokers face a higher risk for CAD and stroke, and there is a dose-response relationship in this association102).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [102] 103) Kono S, Ikeda M, Tokudome S, Nishizumi M, Kuratsune M. Smoking and mortalities from cancer, coronary heart disease and stroke in male Japanese physicians. J Cancer Res Clin Oncol, 1985; 110: 161-164 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Hypertriglyceridemia is a risk factor for ischemic stroke, though the association is weaker than that with CAD.

    “there have been many reports on hypertriglyceridemia being a risk factor for ischemic stroke, though the association is weaker than that with CAD46, 65, 87, 93–95).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [46] 46) Noda H, Iso H, Saito I, Konishi M, Inoue M, Tsugane S, JPHC Study Group. 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. Hypertens Res, 2009; 32: 289-298 source

      Not checked in the free run.

    • cites [65] 65) Okamura T, Kokubo Y, Watanabe M, Higashiyama A, Ono Y, Miyamoto Y, Yoshimasa Y, Okayama A. Triglycerides and non-high-density lipoprotein cholesterol and the incidence of cardiovascular disease in an urban Japanese cohort: The Suita study. Atherosclerosis, 2010; 209: 290-294 source

      Not checked in the free run.

    • cites [87] 88) Iso H, Naito Y, Sato S, Kitamura A, Okamura T, Sankai T, Shimamoto T, Iida M, Komachi Y. Serum triglycerides and risk of coronary heart disease among Japanese men and women. Am J Epidemiol, 2001; 153: 490-499 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Some reports state that the ability of TG to predict cardiovascular events is higher using blood collected in a nonfasting state.

    “some reports have stated that its ability to predict the risk for cardiovascular events is higher using blood collected in a nonfasting state91).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] 92) Castelli WP. Lipids, risk factors and ischaemic heart disease. Atherosclerosis, 1996; 124 Suppl: S1-9 source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Passive smoking is a risk factor for CAD and stroke.

    “Passive smoking is a risk factor for CAD and stroke.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Smoking is a risk factor for CAD, stroke, abdominal aortic aneurysm, and peripheral artery disease.

    “Smoking is a risk factor for CAD, stroke, abdominal aortic aneurysm and peripheral artery disease (PAD).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In J-LIT, the relative risk for CAD in primary prevention subjects was 2.05 times higher in women and 2.15 times in men.

    “A comparison between subjects with hypertension and those without hypertension in the lipid intervention study J-LIT showed that the relative risk for CAD in primary prevention subjects was 2.05 times higher in women and 2.15 times in men124).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [124] 125) Kannel WB, McGee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: The Framing-ham study. Diabetes Care, 1979; 2: 120-126 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Silent myocardial ischemia often coexists in diabetic patients and may result in delayed diagnosis.

    “Silent myocardial ischemia often coexists in diabetic patients, and this may result in delayed diagnosis132).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [132] 133) Goraya TY, Leibson CL, Palumbo PJ, Weston SA, Killian JM, Pfeifer EA, Jacobsen SJ, Frye RL, Roger VL. Coronary atherosclerosis in diabetes mellitus: A population-based autopsy study. J Am Coll Cardiol, 2002; 40: 946-953 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the Hisayama study, CAD incidence was 5.0 per 1,000 person-years in diabetic patients and 1.6 per 1,000 person-years in subjects with normal glucose tolerance.

    “the incidence rate of CAD was 5.0/1,000 person-years for diabetic patients and 1.6/1,000 person-years for subjects with normal glucose tolerance (NGT).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [128] 129) Iso H, Imano H, Kitamura A, Sato S, Naito Y, Tanigawa T, Ohira T, Yamagishi K, Iida M, Shimamoto T. Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women. Diabetologia, 2004; 47: 2137-2144 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In passive smokers, the relative risks for CAD and stroke are 1.31 and 1.25, respectively.

    “it has been revealed in a meta-analysis that the relative risks for CAD and stroke are 1.31115) and 1.25116), respectively.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [115] 116) Oono IP, Mackay DF, Pell JP. Meta-analysis of the association between secondhand smoke exposure and stroke. J Public Health (Oxf), 2011; 33: 496-502 source

      Not checked in the free run.

    • cites [116] 117) Pan A, Wang Y, Talaei M, Hu FB, Wu T. Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol, 2015; 3: 958-967 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    EPOCH-JAPAN estimated that 50% of all cerebrovascular and cardiovascular deaths, 52% of stroke deaths, and 59% of CAD deaths were caused by high BPs exceeding the optimum level.

    “The estimation by EPOCH-JAPAN showed a death rate of 50% from all forms of cerebro- and CVD, 52% from stroke and 59% from CAD. They were all assessed to be caused by high BPs that exceed the optimum level.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [123] 124) Sasaki J, Kita T, Mabuchi H, Matsuzaki M, Matsuzawa Y, Nakaya N, Oikawa S, Saito Y, Shimamoto K, Kono S, Itakura H; J-LIT Study Group. Gender difference in coronary events in relation to risk factors in Japanese hypercholesterolemic patients treated with low-dose simvastatin. Circ J, 2006; 70: 810-814 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the Hisayama study, cerebral infarction incidence was 6.5 per 1,000 person-years in diabetic subjects and 1.9 per 1,000 person-years in subjects with normal glucose tolerance.

    “the incidence rate of cerebral infarction was 6.5/1,000 person-years in diabetic subjects, that significantly higher than the 1.9/1,000 personyears in subjects with NGT128).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [128] 129) Iso H, Imano H, Kitamura A, Sato S, Naito Y, Tanigawa T, Ohira T, Yamagishi K, Iida M, Shimamoto T. Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women. Diabetologia, 2004; 47: 2137-2144 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The relative risk of stroke and stroke-related death was 1.41 times higher for those smoking 20 cigarettes or fewer per day and 1.56 times for those smoking more than 20 sticks.

    “the relative risk of getting stroke and stroke-related death was 1.41 times higher for those who smoke ≤ 20 cigarettes a day and 1.56 times for those who exceed 20 sticks112).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [112] 113) Katanoda K, Marugame T, Saika K, Satoh H, Tajima K, Suzuki T, Tamakoshi A, Tsugane S, Sobue T. Population attributable fraction of mortality associated with tobacco smoking in Japan: A pooled analysis of three large-scale cohort studies. J Epidemiol, 2008; 18: 251-264 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Japanese cross-sectional studies, the proportion of PAD determined by ABI was 3.7 times higher in current smokers, 4.2 times higher in those with 45 or more pack-years, and 3.7 times higher in ex-smokers.

    “Even in cross-sectional studies conducted in Japan, the proportion of PAD, as determined using the ABI, was shown to be 3.7 times higher in current smokers (4.2 times for those with ≥ 45 pack-years) and 3.7 times in ex-smokers.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [114] 115) Barnoya J, Glantz SA. Cardiovascular effects of secondhand smoke: Nearly as large as smoking. Circulation, 2005; 111: 2684-2698 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Smokers have lower HDL-C levels and higher LDL-C and TG levels, with a dose-response relationship.

    “A meta-analysis has shown that smokers have lower HDL-C levels and higher LDL-C and TG levels, and the dose-response relationship has again been observed119).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [119] 120) Ministry of Health, Labour and Welfare of Japan. Review conference on the health impacts of smoking. Segment 5 health impacts of smoke-free tobacco and electronic cigarettes. http://www.mhlw.go.jp/file/05-Shingikai-10901000Kenkoukyoku-Soumuka/0000172687.pdf

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Compared with lifetime nonsmokers, the relative risk for developing CAD and death from it was 2.15 times higher for those smoking 20 cigarettes or fewer per day and 3.28 times for those smoking more than 20 sticks.

    “Compared to lifetime nonsmokers, the relative risk for developing CAD and death from it was 2.15 times higher for those who smoke ≤ 20 cigarettes a day and 3.28 times for those who smoke > 20 sticks in a meta-analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In EPOCH-JAPAN, the hazard ratio for cerebrovascular and cardiovascular disease-related death increases progressively with BP elevation above the optimal level, and this association is stronger in middle-aged adults than in the elderly.

    “the hazard ratio for cerebro- and cardiovascular disease-related death increases progressively with an elevation of BP levels that exceed the optimal level (< 120/80 mmHg). This association was stronger in the middle-aged adults than in the elderly123).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [123] 124) Sasaki J, Kita T, Mabuchi H, Matsuzaki M, Matsuzawa Y, Nakaya N, Oikawa S, Saito Y, Shimamoto K, Kono S, Itakura H; J-LIT Study Group. Gender difference in coronary events in relation to risk factors in Japanese hypercholesterolemic patients treated with low-dose simvastatin. Circ J, 2006; 70: 810-814 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    It has been estimated that 13% of adults in Japan have CKD.

    “It has been estimated that 13% adults in Japan have CKD155)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [155] 156) Joint Committee for Comprehensive Risk Management Chart for the Prevention of Cerebro- Cardiovascular Diseases, Comprehensive risk management for the prevention of cerebro- cardiovascular diseases in Japan. J Atheroscler Thromb, 2017; 24: 749-764 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The risk of composite outcomes in CKD differs greatly depending on cause, GFR, and amount of proteinuria, and severity is classified by CGA using these three factors.

    “As the risk of these composite outcomes differs greatly depending on the cause, GFR and amount of proteinuria (albuminuria), the severity of CKD is classified (CGA classification)153, 154) using these three primary factors.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [153] 154) Japanese Society of Nephrology. Health guidance for the examinees of kidney medical checkup and suggestions to the referral criteria to medical institutions. 2017; 59: 38-42 (in Japanese)

      Not checked in the free run.

    • cites [154] 155) Imai E, Horio M, Watanabe T, Iseki K, Yamagata K, Hara S, Ura N, Kiyohara Y, Moriyama T, Ando Y, Fujimoto S, Konta T, Yokoyama H, Makino H, Hishida A, Matsuo S. Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol, 2009; 13: 621-630 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Coronary lesions in diabetic patients include multiple-vessel disease, highly complicated and diffuse lesions, and multiple calcified lesions.

    “Features of coronary lesions in diabetic patients include (1) multiple-vessel disease, (2) highly complicated and diffuse133, 134) and (3) multiple calcified lesions135).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [133] 134) Kataoka Y, Yasuda S, Morii I, Otsuka Y, Kawamura A, Miyazaki S. Quantitative coronary angiographic studies of patients with angina pectoris and impaired glucose tolerance. Diabetes Care, 2005; 28: 2217-2222 source

      Not checked in the free run.

    • cites [134] 135) Hoff JA, Quinn L, Sevrukov A, Lipton RB, Daviglus M, Garside DB, Ajmere NK, Gandhi S, Kondos GT. The prevalence of coronary artery calcium among diabetic individuals without known coronary artery disease. J Am Coll Cardiol, 2003; 41: 1008-1012 source

      Not checked in the free run.

    • cites [135] 136) Cui R, Iso H, Yamagishi K, Saito I, Kokubo Y, Inoue M, Tsugane S. Diabetes mellitus and risk of stroke and its subtypes among Japanese: The Japan public health center study. Stroke, 2011; 42: 2611-2614 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In diabetic patients, the increase in relative risk of CAD is higher in women than men, resulting in reduced gender differences.

    “But in diabetic patients, it has been reported that the increase in relative risk of CAD was higher in women than men, resulting in reduced gender differences149, 150).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [149] 150) Peters SA, Huxley RR, Woodward M. Diabetes as a risk factor for stroke in women compared with men: A systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes. Lancet, 2014; 383: 1973-1980 source

      Not checked in the free run.

    • cites [150] 151) Fujihara K, Igarashi R, Yamamoto M, Ishizawa M, Matsubayasi Y, Matsunaga S, Kato K, Ito C, Koishi M, Yamanaka N, Kodama S, Sone H. Impact of glucose tolerance status on the development of coronary artery disease among working-age men. Diabetes Metab, 2017; 43: 261-264 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    According to 2014 vital statistics, the mortality rate due to ischemic heart disease per 100,000 was 49.8 for men and 36.6 for women.

    “according to the vital statistics of 2014, the (approximate) rate of mortality due to ischemic heart disease in a target population of 100,000 is 49.8 for men and 36.6 for women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Women have a lower risk for MI and MI-related death than men, but the gender difference decreases with aging.

    “Women have a lower risk for MI and MI-related death than men, but the gender difference decreases with aging.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In a large-scale Canadian cohort study, the association between LDL-C and ASCVD is lower when eGFR is lower, and the association was no longer significant when eGFR was less than 15 mL/min/1.73 m2.

    “According to a large-scale cohort study in Canada157), the association between LDL-C and ASCVD is lower when eGFR is lower, and the association was no longer significant when eGFR was < 15 mL/min/1.73 m2.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [157] 158) Wanner C, Krane V, Marz W, Olschewski M, Mann JF, Ruf G, Ritz E, German Diabetes and Dialysis Study Investigators. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med, 2005; 353: 238-248 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the Hisayama study, CAD incidence in patients with impaired glucose tolerance is 1.9 times higher than in subjects with normal glucose tolerance, lower than the 2.6 times in diabetics.

    “In the Hisayama study, the incidence rate of CAD in patients with IGT is 1.9 times higher than that of subjects with NGT, even though it was lower than the level of 2.6 times in diabetics128).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [128] 129) Iso H, Imano H, Kitamura A, Sato S, Naito Y, Tanigawa T, Ohira T, Yamagishi K, Iida M, Shimamoto T. Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women. Diabetologia, 2004; 47: 2137-2144 source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    CKD is not merely a high-risk condition for end-stage kidney disease but also for ASCVD.

    “CKD is not merely a highrisk condition for end-stage kidney disease but also for ASCVD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Women generally have a lower risk for CAD than men.

    “Women generally have a lower risk for CAD than men.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Compared with male subjects with normal glucose tolerance, male diabetic patients had a 17 times higher CAD risk at ages 31-40 years and a 2 to 3 times higher risk at ages 41-61 years.

    “compared to male subjects with NGT male diabetic patients increased the risk of CAD by 17 times higher at ages 31–40 years, and by 2 to 3 times higher at ages 41 to 61 years”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [151] 152) Nakamura J, Kamiya H, Haneda M, Inagaki N, Tanizawa Y, Araki E, Ueki K, Nakayama T. Causes of death in Japanese patients with diabetes based on the results of a survey of 45,708 cases during 2001-2010: Report of the committee on causes of death in diabetes mellitus. J Diabetes Investig, 2017; 8: 397-410 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the JPHC study, CAD risk was 1.65 times higher in the borderline glucose tolerance group and 3.05 times higher in the diabetic group compared with subjects with normal glucose tolerance.

    “The JPHC study showed that the risk for CAD was 1.65 times higher in the borderline glucose tolerance group and 3.05 times higher in the diabetic group as compared to subjects with NGT, indicating the risk increases before the incidence of diabetes146).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [146] 147) Nakagami T. Hyperglycaemia and mortality from all causes and from cardiovascular disease in five populations of Asian origin. Diabetologia, 2004; 47: 385-394 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the J-LIT study, the incidence rate was 0.9 per 1,000 person-years in primary prevention patients and 4.5 per 1,000 person-years in CAD patients.

    “In the J-LIT study, the incidence rate in primary prevention patients was 0.9/1,000 person-years 180) and 4.5/1,000 person-years in CAD patients173).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [180] 181) Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K, for the Japan EPA lipid intervention study (JELIS) Investigators. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised openlabel, blinded endpoint analysis. Lancet, 2007; 369: 1090-1098 source

      Not checked in the free run.

    • cites [173] 174) Furukawa Y, Ehara N, Taniguchi R, Haruna Y, Ozasa N, Saito N, Doi T, Hoshino K, Tamura T, Shizuta S, Abe M, Toma M, Morimoto T, Teramukai S, Fukushima M, Kita T, Kimura T, CREDO-Kyoto Investigators. Coronary risk factor profile and prognostic factors for young Japanese patients undergoing coronary revascularization. Circ J, 2009; 73: 1459-1465 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    There was almost no difference between the mortality rates of cerebral infarction for men and women, which were 25.4 and 28.8 per 100,000, respectively.

    “There was almost no difference between the mortality rates of cerebral infarction for men and women (target population of 100,000), which were 25.4 and 28.8, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Traditional risk factors are associated with genetic predisposition and are influenced by habits within the family.

    “Traditional risk factors (high LDL-C, low HDL-C, hypertension, diabetes, and smoking) are associated with genetic predisposition and are influenced by habits within the family.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    A family history of CAD is considered to include genetic and environmental risk factors.

    “a family history of CAD is considered to also include genetic and environmental risk factors, a fact that is already known.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In JELIS, the incidence rate was 1.6 per 1,000 person-years in primary prevention patients and 6.8 per 1,000 person-years in patients with CAD.

    “In JELIS, primary prevention patients had an incidence rate of 1.6/1,000 person-years while the rate was 6.8/1,000 person-years in patients with CAD181).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [181] 182) The Japanese Coronary Artery Disease (JCAD) Study Investigators. Current status of the background of patients with coronary artery disease in Japan. Circ J, 2006; 70: 1256-1262 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A family history of CAD, especially in first-degree close relatives and a family history of premature CAD, are strong risk factors for CAD.

    “A family history of CAD, especially in first-degree close relatives (parents, children, brothers and sisters), and a family history of premature CAD (age of incidence: < 55 years for men and < 65 years for women) are strong risk factors for CAD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Up to the 90s age group, the mortality rate of cerebral infarction was lower in women than men.

    “Up to the 90s age group, the mortality rate of cerebral infarction was lower in women than men.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The incidence of CAD differs in the various regions and populations in Japan, and is higher in cities than in rural areas.

    “The incidence of CAD differs in the various regions and populations in Japan, and is higher in cities than in rural areas98)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [98] 99) Takii T, Yasuda S, Takahashi J, Ito K, Shiba N, Shirato K, Shimokawa H. Trends in acute myocardial infarction incidence and mortality over 30 years in Japan: Report from the Miyagi-AMI Registry Study. Circ J, 2010; 74: 93-100 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Diabetic patients who are complicated with conditions shown in Table 3b had a high risk for recurrence of CAD.

    “because diabetic patients who are complicated with conditions shown in Table 3b had a high risk for recurrence of CAD”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Findingnone given

    Patients with FH are difficult to treat, and their risk of CAD in the future is extremely high.

    “As patients with FH are difficult to treat, and their risk of CAD in the future is extremely high”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    In both scores, fasting LDL-C value is calculated using the Friedewald formula.

    “In both scores, the fasting LDL-C value is calculated using the Friedewald formula.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    NIPPON DATA80 baseline year is 1980, and when this baseline hazard is applied to more recent cohort populations, the estimated mortality of the high-risk group is higher than the actual measured mortality of recent populations.

    “the fact that the baseline year is 1980, and when this baseline hazard is applied to more recent cohort populations, the estimated mortality of the high-risk group is higher than the actual measured mortality of recent populations341).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [341] 342) Tanaka T, Okamura T. Blood cholesterol level and risk of stroke in community-based or worksite cohort studies: A review of Japanese cohort studies in the past 20 years. Keio J Med, 2012; 61: 79-88 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Findingnone given

    An LDL-C level of ≥180 mg/dL has always indicated a high risk for CAD, and may also suggest the presence of familial hypercholesterolemia (FH).

    “An LDL-C level of ≥ 180 mg/dL has always indicated a high risk for CAD, and may also suggest the presence of familial hypercholesterolemia (FH).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Currently available risk scoring tools can be used even if the patient is on medication, but the actual risks of cerebro- and cardiovascular diseases differ in patients with or without antihypertensive drug treatment.

    “The currently available risk scoring tools can be used even if the patient is on medication, but the actual risks of cerebro- and cardiovascular diseases differ in patients with or without antihypertensive drug treatment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The actual risks of cerebro- and cardiovascular diseases differ in patients with or without antihypertensive drug treatment.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Stroke comprises a large proportion of cases of cerebro- and cardiovascular disease in Japan.

    “Stroke comprises a large proportion of the cases of cerebro- and cardiovascular disease in Japan.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Few available medications are effective for increasing low HDL-C, and some reports have found that CAD risk is low if a low HDL level is not accompanied by other lipid abnormalities.

    “Few available medications are effective for increasing low HDL-C, and some reports have found that CAD risk is low if a low HDL level is not accompanied by other lipid abnormalities351).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [351] 352) Tan CE, Glantz SA. Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis. Circulation, 2012; 126: 2177-2183 source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    The NIPPON DATA80 risk chart has advantages for assessment of absolute risk, including random sampling across Japan, a pre-statin baseline survey, and high suitability for observing the natural course of disease.

    “The NIPPON DATA80 had various advantages, including the fact that groups were selected from all over Japan by random sampling, the chart was based on a baseline survey conducted before statins were available and its high suitability for the observation of the natural course of disease, making it very useful for the assessment of absolute risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Obesity, especially excess visceral fat accumulation, is considered to be an independent risk factor for CVD and promotes atherosclerosis directly or indirectly via dyslipidemia, impaired glucose tolerance, hypertension and the dysregulated production of adipocytokine.

    “Obesity, especially excess visceral fat accumulation, is considered to be an independent risk factor for CVD and promotes atherosclerosis directly or indirectly via dyslipidemia, impaired glucose tolerance, hypertension and the dysregulated production of adipocytokine362–365).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [362] 363) Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed), 1984; 288: 1401-1404 source

      Not checked in the free run.

    • cites [363] 364) Carr DB, Utzschneider KM, Hull RL, Kodama K, Retzlaff BM, Brunzell JD, Shofer JB, Fish BE, Knopp RH, Kahn SE. Intra-abdominal fat is a major determinant of the national cholesterol education program adult treatment panel III criteria for the metabolic syndrome. Diabetes, 2004; 53: 2087-2094 source

      Not checked in the free run.

    • cites [364] 365) Matsuzawa Y. The metabolic syndrome and adipocytokines. FEBS Lett, 2006; 580: 2917-2921 source

      Not checked in the free run.

    • cites [365] 366) Japan Society for the Study of Obesity, ed.: 2011 Diagnostic guidelines for obesity. J Jpn Soc Study of Obesity, 2011; 17: 1-78 (in Japanese)

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    The expectation of weight gain hinders the start of smoking cessation and causes resumption of smoking.

    “Although the expectation of weight gain hinders the start of smoking cessation and causes resumption of smoking”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The 2016 medical fee revision expanded coverage to qualifying minors.

    “The 2016 medical fee revision expanded coverage to qualifying minors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    A recent meta-analysis reported a 4-5 kg increase in body weight 1 year after quitting smoking, with the increase quite pronounced within the first 3 months after cessation.

    “a recent meta-analysis reported a 4–5 kg increase in body weight 1 year after quitting smoking, with the increase quite pronounced within the first 3 months after cessation358).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [358] 359) Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH. Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial. Am Heart J, 2011; 161: 145-151 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In ASCVD patients, the benefits of smoking cessation are apparent soon after quitting, and the longer the duration of abstinence from smoking, the greater is the decrease of risk.

    “In ASCVD patients, the benefits of smoking cessation are apparent soon after quitting, and the longer the duration of abstinence from smoking, the greater is the decrease of risk107).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [107] 108) Higashiyama A, Okamura T, Ono Y, Watanabe M, Kokubo Y, Okayama A. Risk of smoking and metabolic syndrome for incidence of cardiovascular disease--comparison of relative contribution in urban Japanese population: The Suita study. Circ J, 2009; 73: 2258-2263 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Short-term worsening of blood glucose and lipid levels may be observed during that interval, but improvement in insulin resistance, increase in HDL-C and reduction in oxidized LDL have been reported regardless of weight gain.

    “Short-term worsening of blood glucose and lipid levels may be observed during that interval, but improvement in insulin resistance117), increase in HDL-C359) and reduction in oxidized LDL360) have been reported regardless of weight gain.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [117] 118) Ishizaka N, Ishizaka Y, Toda E, Hashimoto H, Nagai R, Yamakado M. Association between cigarette smoking, metabolic syndrome, and carotid arteriosclerosis in Japanese individuals. Atherosclerosis, 2005; 181: 381-388 source

      Not checked in the free run.

    • cites [359] 360) Komiyama M, Shimada S, Wada H, Yamakage H, Satoh-Asahara N, Shimatsu A, Akao M, Morimoto T, Takahashi Y, Hasegawa K. Time-dependent changes of atherosclerotic LDL complexes after smoking cessation. J Atheroscler Thromb, 2016; 23: 1270-1275 source

      Not checked in the free run.

    • cites [360] 361) Clair C, Rigotti NA, Porneala B, Fox CS, D’Agostino RB, Pencina MJ, Meigs JB. Association of smoking cessation and weight change with cardiovascular disease among adults with and without diabetes. JAMA, 2013; 309: 1014-1021 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Passive smoking also increases CAD and stroke risk.

    “Passive smoking also increases CAD and stroke risk115, 116)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [115] 116) Oono IP, Mackay DF, Pell JP. Meta-analysis of the association between secondhand smoke exposure and stroke. J Public Health (Oxf), 2011; 33: 496-502 source

      Not checked in the free run.

    • cites [116] 117) Pan A, Wang Y, Talaei M, Hu FB, Wu T. Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol, 2015; 3: 958-967 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    As with other drug dependencies, symptoms of nicotine withdrawal appear soon after quitting, and that makes it difficult for many smokers to quit.

    “As with other drug dependencies, symptoms of nicotine withdrawal appear soon after quitting, and that makes it difficult for many smokers to quit.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Rapid weight loss resulting from extensive calorie restriction may lead to rapid rebound weight gain.

    “Rapid weight loss resulting from extensive calorie restriction may lead to rapid rebound weight gain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Metabolic syndrome has been proposed as a high-risk condition for ASCVD independent of hyper-LDL cholesterolemia.

    “Metabolic syndrome has been proposed as a high-risk condition for ASCVD independent of hyper-LDL cholesterolemia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Regardless of a history of ASCVD, smoking cessation decreases the development and subsequent progression of ASCVD, and the risk of death due to ASCVD.

    “regardless a history of ASCVD, smoking cessation decreases the development and subsequent progression of ASCVD, and the risk of death due to ASCVD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Findingnone given

    Hyper-LDL cholesterolemia is a major risk factor for ASCVD, and its management protocol has been established.

    “Hyper-LDL cholesterolemia is a major risk factor for ASCVD, and its management protocol has been established.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In Japan, when both medical facilities and patients satisfy certain requirements, health insurance coverage is applied for smoking cessation treatment for 12 weeks.

    “In Japan, when both medical facilities and patients satisfy certain requirements, health insurance coverage is applied for smoking cessation treatment for 12 weeks355).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [355] 356) Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev, 2012; 11: CD000146 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    For screening of obesity disease in daily clinical practice, a waist circumference at the umbilical level of ≥85 cm for men and ≥90 cm for women is used as the criteria of visceral fat accumulation.

    “For screening of obesity disease in daily clinical practice, a waist circumference at the umbilical level of ≥ 85 cm for men and ≥ 90 cm for women is used as the criteria of visceral fat accumulation368).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [368] 369) Muramoto A, Matsushita M, Kato A, Yamamoto N, Koike G, Nakamura M, Numata T, Tamakoshi A, Tsushita K. Three percent weight reduction is the minimum requirement to improve health hazards in obese and overweight people in Japan. Obes Res Clin Pract.,2014; 8: e466-475 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    The diagnostic criteria of metabolic syndrome include no criterion concerning the LDL-C level.

    “Therefore, the diagnostic criteria of metabolic syndrome include no criterion concerning the LDL-C level.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Decreasing the number of cigarettes smoked or switching to low-nicotine or low-tar tobacco does not lead to a reduction in risk.

    “As decreasing the number of cigarettes smoked or switching to low-nicotine or low-tar tobacco does not lead to a reduction in risk”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    In Japan, the ideal body weight is defined to be a BMI of 22, which has the lowest morbidity, and a BMI ≥25 is diagnosed as obesity.

    “In Japan, the ideal body weight is defined to be a BMI of 22, which has the lowest morbidity, and a BMI ≥ 25 is diagnosed as obesity366).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [366] 367) The Examination Committee of Criteria for Obesity Disease in Japan (2002) Japan Society for the Study of Obesity: New criteria for obesity disease in Japan. Circ J, 2002; 66: 987-992 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Japan, active support of lifestyle modification resulted in a weight loss of ≥3% in obese individuals within 1 year, could reduce LDL-C, TG, uric acid, and blood pressure levels, improve blood glucose control, and increase HDL-C levels significantly.

    “In Japan, active support of lifestyle modification resulted in a weight loss of ≥ 3% in obese individuals within 1 year, could reduce LDL-C, TG, uric acid, and blood pressure levels, improve blood glucose control, and increase HDL-C levels significantly320, 372).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [320] 321) Nakamura T, Tokunaga K, Shimomura I, Nishida M, Yoshida S, Kotani K, Islam AH, Keno Y, Kobatake T, Nagai Y. Contribution of visceral fat accumulation to the development of coronary artery disease in non-obese men. Atherosclerosis, 1994; 107: 239-246 source

      Not checked in the free run.

    • cites [372] 373) Svendsen OL, Hassager C, Christiansen C. Effect of an energy-restrictive diet, with or without exercise, on lean tissue mass, resting metabolic rate, cardiovascular risk factors, and bone in overweight postmenopausal women. Am J Med, 1993; 95: 131-140 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    An RCT comparing an energy-restrictive diet with an energy-restrictive diet+exercise in overweight postmenopausal women found decreases in body weight and amount of body fat; decreased TG, TC, LDL-C, and the LDL-C/HDL-C ratio; and a decrease in SBP in both groups.

    “An RCT comparing an energy-restrictive diet with an energy-restrictive diet+exercise in overweight postmenopausal women found decreases in body weight and amount of body fat; decreased TG, TC, LDL-C, and the LDL-C/HDL-C ratio; and a decrease in SBP in both groups373).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [373] 374) Kuller LH, Simkin-Silverman LR, Wing RR, Meilahn EN, Ives DG. Women’s healthy lifestyle project: A randomized clinical trial: Results at 54 months. Circulation, 2001; 103: 32-37 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The increase in HDL-C was positively correlated with the duration of exercise, and exercising for ≥ 121 minutes/week significantly increased HDL-C levels.

    “The increase in HDL-C was positively correlation with the duration of exercise, and exercising for ≥ 121 minutes/week significantly increased the levels.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [612] 614) Kelley GA, Kelley KS. Aerobic exercise and lipids and lipoproteins in men: A meta-analysis of randomized controlled trials. J Mens Health Gend, 2006; 3: 61-70 source

      Not checked in the free run.

  • The quote only partly states this claim.

    Findingcitation

    Among 8 reports of systematic review and meta-analysis of RCTs comparing exercise and non-exercise control, significant decreases in LDL-C and TG levels were reported in two articles, respectively.

    “Among 8 reports of systematic review and metaanalysis of RCTs with comparison of exercise and non-exercise control including Japanese participants and were published after 2,000, significant decreases in LDL-C and TG levels were reported in two articles, respectively.”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [577] 579) Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. Physical activity and the risk of type 2 diabetes: A systematic review and dose-response meta-analysis. Eur J Epidemiol, 2015; 30: 529-542 source

      Not checked in the free run.

    • cites [607] 609) Kelley GA, Kelley KS, Tran ZV. Walking, lipids, and lipoproteins: A meta-analysis of randomized controlled trials. Prev Med, 2004; 38: 651-661 source

      Not checked in the free run.

    • cites [608] 610) Kelley GA, Kelley KS, Tran ZV. Aerobic exercise and lipids and lipoproteins in women: A meta-analysis of randomized controlled trials. J Womens Health (Larchmt), 2004; 13: 1148-1164 source

      Not checked in the free run.

    • cites [609] 611) Kelley GA, Kelley KS, Tran ZV. Exercise, lipids, and lipoproteins in older adults: A meta-analysis. Prev Cardiol, 2005; 8: 206-214 source

      Not checked in the free run.

    • cites [610] 612) Kodama S, Tanaka S, Saito K, Shu M, Sone Y, Onitake F, Suzuki E, Shimano H, Yamamoto S, Kondo K, Ohashi Y, Yamada N, Sone H. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: A meta-analysis. Arch Intern Med, 2007; 167: 999-1008 source

      Not checked in the free run.

    • cites [611] 613) Kuhle CL, Steffen MW, Anderson PJ, Murad MH. Effect of exercise on anthropometric measures and serum lipids in older individuals: A systematic review and meta-analysis. BMJ Open, 2014; 4: e005283 source

      Not checked in the free run.

    • cites [612] 614) Kelley GA, Kelley KS. Aerobic exercise and lipids and lipoproteins in men: A meta-analysis of randomized controlled trials. J Mens Health Gend, 2006; 3: 61-70 source

      Not checked in the free run.

    • cites [613] 615) Kelley GA, Kelley KS. Impact of progressive resistance training on lipids and lipoproteins in adults: Another look at a meta-analysis using prediction intervals. Prev Med, 2009; 49: 473-475 source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Even in secondary prevention, the incidence of cardiovascular events is clearly high if FH, ACS, DM, noncardiogenic cerebral infarction, PAD, CKD, and metabolic syndrome are also present, or if there is an overlap of the major risk factors or continued smoking.

    “Even in secondary prevention, the incidence of cardiovascular events is clearly high if FH, ACS, DM, noncardiogenic cerebral infarction, PAD, CKD, and metabolic syndrome are also present, or if there is an overlap of the major risk factors or continued smoking (Table 3) (refer to Chapter 3, 1–8: History of CAD).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    65% of patients with ACS and 55% of other secondary prevention patients achieved an LDL-C management target of < 100 mg/dL in a recent survey in Japan.

    “A recent survey in Japan, found that 65% patients with ACS, and 55% for other secondary prevention patients, achieved an LDL-C management target of < 100 mg/dL.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [626] 628) Ford I, Murray H, McCowan C, Packard CJ. Long-term safety and efficacy of lowering low-density lipoprotein cholesterol with statin therapy: 20-year follow-up of West of Scotland Coronary Prevention Study. Circulation, 2016; 133: 1073-1080 source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Although the absolute risk of CAD is lower in the Japanese population than in Western countries, the relative risk of LDL-C and CAD is similar.

    “Although the absolute risk of CAD is lower in the Japanese population than in Western countries, the relative risk of LDL-C and CAD is similar.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Statins competitively inhibit HMG-CoA reductase, which is a rate-limiting enzyme of cholesterol synthesis, in turn suppressing cholesterol biosynthesis.

    “Statins competitively inhibit HMG-CoA reductase, which is a rate-limiting enzyme of cholesterol synthesis, in turn suppressing cholesterol biosynthesis657).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [657] 659) Bakker-Arkema RG, Davidson MH, Goldstein RJ, Davignon J, Isaacsohn JL, Weiss SR, Keilson LM, Brown WV, Miller VT, Shurzinske LJ, Black DM. Efficacy and safety of a new HMG-CoA reductase inhibitor, atorvastatin, in patients with hypertriglyceridemia. JAMA, 1996; 275: 128-133 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Myopathy-like symptoms, such as hepatic disorders, an increased creatine kinase (CK) level, and muscular weakness, have been reported as adverse reactions to statins.

    “Myopathy-like symptoms, such as hepatic disorders, an increased creatine kinase (CK) level, and muscular weakness, have been reported as adverse reactions to statins.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Ezetimibe increased the HDL-C level by 8-9% while decreasing the TG level by 20-30%.

    “It also increased the HDL-C level by 8–9% while decreasing the TG level by 20–30%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Rhabdomyolysis has been reported as a very rare complication of statins.

    “Rhabdomyolysis, characterized by an increased myoglobin level in the blood and urine, has also been reported, though this complication is very rare.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingcitation

    Larger suppressive effects on cardiovascular events can be achieved by maintaining the LDL-C level at < 50 mg/dL.

    “A review performed outside of Japan reported that larger suppressive effects on cardiovascular events can be achieved by maintaining the LDL-C level at < 50 mg/dL646).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [646] 648) Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Helo P, Huttunen JK, Kaitaniemi P, Koskinen P, Manninen V. Helsinki Heart Study: Primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med, 1987; 317: 1237-1245 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The subsequent activation of SREBP2 promotes LDL receptor synthesis and results in a reduction in the blood LDL-C level.

    “The subsequent activation of SREBP2 promotes LDL receptor synthesis and results in a reduction in the blood LDL-C level658).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [658] 660) Pharmaceuticals and Medical Devices Agency. Revisions to the “Precautions of use” of HMG-CoA reducatase inhibitor-containing pharmaceutical drugs. 2016 https://www.pmda.go.jp/files/000214541.pdf (in Japanese)

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Combination therapy with 10 mg of ezetimibe and a statin at the usual dose decreases the LDL-C level by approximately 35-50%, which is equivalent to the effects achieved using a maximum statin dose alone.

    “Therefore, the combined use of ezetimibe with statins is ideal and provides a synergistic effect: combination therapy with 10 mg of ezetimibe and a statin at the usual dose decreases the LDL-C level by approximately 35–50%664–666), which is equivalent to the effects achieved using a maximum statin dose alone.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [664] 666) Ballantyne CM, Houri J, Notarbartolo A, Melani L, Lipka LJ, Suresh R, Sun S, LeBeaut AP, Sager PT, Veltri EP, Ezetimibe Study Group. Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia: A prospective, randomized, double-blind trial. Circulation, 2003; 107: 2409-2415 source

      Not checked in the free run.

    • cites [665] 667) Thomopoulos C, Skalis G, Michalopoulou H, Tsioufis C, Makris T. Effect of low-density lipoprotein cholesterol lowering by ezetimibe/simvastatin on outcome incidence: Overview, meta-analyses, and meta-regression analyses of randomized trials. Clin Cardiol, 2015; 38: 763-769 source

      Not checked in the free run.

    • cites [666] 668) Takada T, Yamanashi Y, Konishi K, Yamamoto T, Toyoda Y, Masuo Y, Yamamoto H, Suzuki H. NPC1L1 is a key regulator of intestinal vitamin k absorption and a modulator of warfarin therapy. Sci Transl Med, 2015; 7: 275ra223 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A meta-analysis of large-scale clinical trials involving combination therapy with ezetimibe and statins in patients with high-risk conditions such as FH, ACS, and PAD, confirmed the safety of combination therapy and cardiovascular event suppression resulting from its LDL-C-lowering effects.

    “A meta-analysis of large-scale clinical trials involving combination therapy with ezetimibe and statins in patients with high-risk conditions such as FH, ACS, and PAD, confirmed the safety of combination therapy and cardiovascular event suppression resulting from its LDL-C-lowering effects667).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [667] 669) The lipid research clinics coronary primary prevention trial results. I. Reduction in incidence of coronary heart disease. JAMA, 1984; 251: 351-364 source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    PCSK9 inhibitors decrease TG levels by 20-25% and increase HDL-C levels by 10-15%.

    “PCSK9 inhibitors decrease TG levels by 20–25% and increases HDL-C levels by 10–15%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Resin administration results in a decreased LDL-C level, as well as VLDL synthesis and an increased blood TG level because of bile acid absorption.

    “Resin administration results in a decreased LDL-C level, as well as VLDL synthesis and an increased blood TG level because of bile acid absorption.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Probucol decreases the LDL-C level and also decreases the HDL-C level.

    “In addition to decreasing the LDL-C level, this drug also decreases the HDL-C level.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    PCSK9 inhibitors bind specifically to and inhibit the actions of the PCSK9 protein, which is involved in the degradation of LDL receptors in the liver, thereby showing a blood LDL-C-lowering effect.

    “These drugs bind specifically to and inhibit the actions of the PCSK9 (proprotein convertase subtilisin/kexin type 9) protein, which is involved in the degradation of LDL receptors in the liver. In doing so, it increases the recycling of LDL receptors, thereby showing a blood LDL-C-lowering effect681).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [681] 683) Teramoto T, Kobayashi M, Tasaki H, Yagyu H, Higashikata T, Takagi Y, Uno K, Baccara-Dinet MT, Nohara A. Efficacy and safety of alirocumab in Japanese patients with heterozygous familial hypercholesterolemia or at high cardiovascular risk with hypercholesterolemia not adequately controlled with statins . ODESSEY JAPAN Randomized Controlled Trial. Circ J, 2016; 80: 19801987 source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    PCSK9 inhibitors decrease the Lp(a) level, on which statins do not show a lowering effect.

    “These inhibitors also decrease the Lp(a) level, on which statins do not show a lowering effect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    IMT is used to reflect the degree of systemic arteriosclerosis or as an alternative assessment factor for predicting the risk of co-existence or onset of ASCVD (e.g., CAD, PAD, cerebrovascular diseases).

    “It is also used to reflect the degree of systemic arteriosclerosis or as an alternative assessment factor for predicting the risk of co-existence or onset of ASCVD (e.g., CAD, PAD, cerebrovascular diseases, etc.)5–8).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [5] 5) Nezu T, Hosomi N, Aoki S, Matsumoto M. Carotid intima-media thickness for atherosclerosis. J Atheroscler Thromb, 2016; 23: 18-31 source

      Not checked in the free run.

    • cites [6] 6) O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular health study collaborative research group. N Engl J Med, 1999; 340: 14-22 source

      Not checked in the free run.

    • cites [7] 7) del Sol AI, Moons KG, Hollander M, Hofman A, Koudstaal PJ, Grobbee DE, Breteler MM, Witteman JC, Bots ML. Is carotid intima-media thickness useful in cardiovascular disease risk assessment? The Rotterdam Study. Stroke, 2001; 32: 1532-1538 source

      Not checked in the free run.

    • cites [8] 8) Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: A systematic review and metaanalysis. Circulation, 2007; 115: 459-467 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The NIPPON DATA80 has major issues: using death instead of disease onset as the outcome and the absence of information on LDL-C and HDL-C.

    “using death instead of disease onset as the outcome and the absence of information on LDL-C and HDL-C are major issues”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    FMD starts decreasing from early stages of arteriosclerosis and is useful for the initial assessment of ASCVD.

    “FMD starts decreasing from early stages of arteriosclerosis31, 32), and it is therefore useful for the initial assessment of ASCVD.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] 31) Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R, Force International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: A report of the international brachial artery reactivity task force. J Am Coll Cardiol, 2002; 39: 257-265 source

      Not checked in the free run.

    • cites [32] 32) Celermajer DS, Sorensen KE, Bull C, Robinson J, Dean-field JE. Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Am Coll Cardiol, 1994; 24: 1468-1474 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    CAVI is an index of arterial elasticity whose measurement is not dependent on blood pressure.

    “A feature of CAVI is its nondependence on BP during measurement28).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] 28) Shirai K, Hiruta N, Song M, Kurosu T, Suzuki J, Tomaru T, Miyashita Y, Saiki A, Takahashi M, Suzuki K, Takata M. Cardio-ankle vascular index (CAVI) as a novel indicator of arterial stiffness: Theory, evidence and perspectives. J Atheroscler Thromb, 2011; 18: 924-938 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The Suita study, which used CAD as its outcome, is most suitable for risk calculation in the 2017 JAS guidelines.

    “SR indicated that the Suita study, which used CAD as its outcome, is most suitable for risk calculation in this set of guidelines.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A conflict of interest statement has been obtained from each member of the committee involved in drafting the Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017.

    “a conflict of interest (COI) statement has been obtained from each member of the committee involved in drafting the Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Multidetector CT (MDCT) has excellent specificity, and organic coronary stenosis can almost be ruled out if no abnormalities are detected using this technique.

    “It has excellent specificity14–17), and organic coronary stenosis can almost be ruled out if no abnormalities are detected using this technique.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [14] 14) Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, Decramer I, Van Hoe LR, Wijns W, Hunink MG. Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: Meta-analysis. Radiology, 2007; 244: 419-428 source

      Not checked in the free run.

    • cites [15] 15) Schroeder S, Achenbach S, Bengel F, Burgstahler C, Cademartiri F, de Feyter P, George R, Kaufmann P, Kopp AF, Knuuti J, Ropers D, Schuijf J, Tops LF, Bax JJ, Working Group Nuclear Cardiology and Cardiac CT; European Society of Cardiology; European Council of Nuclear Cardiology. Cardiac computed tomography: Indications, applications, limitations, and training requirements: Report of a writing group deployed by the working group nuclear cardiology and cardiac CT of the European society of cardiology and the European council of nuclear cardiology. Eur Heart J, 2008; 29: 531-556 source

      Not checked in the free run.

    • cites [16] 16) Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, Delago A, Min JK. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: Results from the prospective multicenter accuracy (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol, 2008; 52: 1724-1732 source

      Not checked in the free run.

    • cites [17] 17) Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, Paul N, Clouse ME, Shapiro EP, Hoe J, Lardo AC, Bush DE, de Roos A, Cox C, Brinker J, Lima JA. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med, 2008; 359: 2324-2336 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Aging, hypertension, diabetes, and pulse rate are CVD risk factors that have been reported to cause increased baPWV, and they show a good correlation with the Framingham Risk Score.

    “Aging22), hypertension23), diabetes24), and pulse rate22) are CVD risk factors that have been reported to cause increased baPWV, and they show a good correlation with the Framingham Risk Score.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [22] 22) Tomiyama H, Yamashina A, Arai T, Hirose K, Koji Y, Chikamori T, Hori S, Yamamoto Y, Doba N, Hinohara S. Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement--a survey of 12517 subjects. Atherosclerosis, 2003; 166: 303 source

      Not checked in the free run.

    • cites [23] 23) Yamashina A, Tomiyama H, Arai T, Koji Y, Yambe M, Motobe H, Glunizia Z, Yamamoto Y, Hori S. Nomogram of the relation of brachial-ankle pulse wave velocity with blood pressure. Hypertens Res, 2003; 26: 801-806 source

      Not checked in the free run.

    • cites [24] 24) Ohnishi H, Saitoh S, Takagi S, Ohata J, Isobe T, Kikuchi Y, Takeuchi H, Shimamoto K. Pulse wave velocity as an indicator of atherosclerosis in impaired fasting glucose: The Tanno and Sobetsu study. Diabetes Care, 2003; 26: 437-440 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Intima-media thickness (IMT) is assessed as the thickness adjusted by age.

    “IMT is assessed as the thickness adjusted by age4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] 4) Homma S, Hirose N, Ishida H, Ishii T, Araki G. Carotid plaque and intima-media thickness assessed by b-mode ultrasonography in subjects ranging from young adults to centenarians. Stroke, 2001; 32: 830-835 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The authors formulated the CQ 'Does an assessment method that predicts the incidence of or death due to ASCVD in the Japanese exist?' and performed a systematic review.

    “Specifically, we formulated the CQ, “Does an assessment method that predicts the incidence of or death due to ASCVD in the Japanese exist?”, and performed an SR.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The determination of the incidence rate of CAD instead of the overall risk assessment has enabled a clearer demonstration of the importance of each risk.

    “We believe that the determination of the incidence rate of CAD instead of the overall risk assessment has enabled a clearer demonstration of the importance of each risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    TC predicts the occurrence of and death from stroke.

    “TC therefore predicts the occurrence of and death from stroke.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    The accuracy of the direct LDL-C method and non-HDL-C calculation cannot be guaranteed when TG levels are 1000 mg/dL or higher and 600 mg/dL or higher, respectively.

    “However, the accuracy of the direct method and the non-HDL-C calculation cannot be guaranteed when the TG level is ≥ 1000 mg/dL101) and ≥ 600 mg/dL, respectively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [101] 102) National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Atlanta (GA). Centers for Disease Control and Prevention (US). Chapter 8. The health consequences of smoking-50 years of progress: A report of the Surgeon General, 2014: 411-457

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Smoking increases the risk for diabetes, dyslipidemia, and metabolic syndrome, contributing to an added risk for ASCVD.

    “It also increases the risk for diabetes, dyslipidemia and metabolic syndrome, in turn contributing to an added risk for ASCVD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Randomized controlled trials show that statin use did not significantly decrease ASCVD risk in dialysis patients, suggesting the importance of implementing effective measures in patients with earlier stages of CKD.

    “This finding is consistent with the results of randomized controlled trials revealing that the use of statin did not decrease the risk for ASCVD significantly in dialysis patients158, 159), suggesting the importance of implementing effective measures on patients with earlier stages of CKD.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [158] 159) Fellstrom BC, Jardine AG, Schmieder RE, Holdaas H, Bannister K, Beutler J, Chae DW, Chevaile A, Cobbe SM, Gronhagen-Riska C, De Lima JJ, Lins R, Mayer G, McMahon AW, Parving HH, Remuzzi G, Samuelsson O, Sonkodi S, Sci D, Suleymanlar G, Tsakiris D, Tesar V, Todorov V, Wiecek A, Wuthrich RP, Gottlow M, Johns-son E, Zannad F, AURORA Study Group. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med, 2009; 360: 1395-1407 source

      Not checked in the free run.

    • cites [159] 160) Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation, 1998; 97: 1837-1847 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Women in their 70s have an ischemic heart disease mortality rate almost the same as men in their 60s, showing that the risk for ASCVD is not low for elderly women.

    “Women in the 70s have a mortality rate that is almost the same as men in the 60s, which goes to show that the risk for ASCVD is not low for elderly women164).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [164] 165) Silberberg JS, Wlodarczyk J, Fryer J, Robertson R, Hens-ley MJ. Risk associated with various definitions of family history of coronary heart disease. The Newcastle Family History Study II. Am J Epidemiol, 1998; 147: 1133-1139 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Both CVD and stroke were not significantly correlated with the progress of IMT.

    “However, it was reported in the results of a meta-analysis that both CVD and stroke were not seen to be significantly correlated with the progress of IMT189).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [189] 190) Olin JW, Allie DE, Belkin M, Bonow RO, Casey DE Jr, Creager MA, Gerber TC, Hirsch AT, Jaff MR, Kaufman JA, Lewis CA, Martin ET, Martin LG, Sheehan P, Stewart KJ, Treat-Jacobson D, White CJ, Zheng ZJ; American Association of Cardiovascular and Pulmonary Rehabilitation; American Diabetes Association; Society for Atherosclerosis Imaging and Prevention; Society for Cardiovascular Magnetic Resonance; Society of Cardiovascular Computed Tomography; PAD Coalition; American Academy of Podiatric Practice Management; ACCF/ AHA Task Force on Performance Measures, Masoudi FA, Bonow RO, DeLong E, Erwin source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Patients in Japan who have a history of stroke are at high risk for developing CAD, especially those with noncardiogenic cerebral infarction originating from arteriosclerotic lesions.

    “Patients in Japan who have a history of stroke are considered to be at a high risk for developing CAD, especially those with noncardiogenic cerebral infarction originating from arteriosclerotic lesions.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [184] 185) Goto S, Ikeda Y, Shimada K, Uchiyama S, Origasa H, Kobayashi H, J-TRACE Investigators. One-year cardiovascular event rates in Japanese outpatients with myocardial infarction, stroke, and atrial fibrillation. -results from the Japan Thrombosis Registry for Atrial Fibrillation, Coronary, or Cerebrovascular Events (J-TRACE). Circ J, 2011; 75: 2598-2604 source

      Not checked in the free run.

    • cites [185] 186) Kitagawa K, Hougaku H, Yamagami H, Hashimoto H, Itoh T, Shimizu Y, Takahashi D, Murata S, Seike Y, Kondo K, Hoshi T, Furukado S, Abe Y, Yagita Y, Sakaguchi M, Tagaya M, Etani H, Fukunaga R, Nagai Y, Matsumoto M, Hori M, OSACA2 Study Group. Carotid intima-media thickness and risk of cardiovascular events in high-risk patients. Results of the osaka follow-up study for carotid atherosclerosis 2 (OSACA2 Study). Cerebrovasc Dis, 2007; 24: 35-42 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Even though coronary artery lesions are found at high rates when RAS is present and RAS is an important high-risk condition in CVD, there is insufficient evidence showing that it is a direct primary risk factor for ASCVD.

    “Even though coronary artery lesions are found at high rates when RAS is present and RAS is an important high-risk condition in CVD, there is insufficient evidence showing that it is a direct primary risk factor for ASCVD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Hollier et al. study of 1,087 patients who had undergone open surgical repair for AAA, cardiovascular-related causes made up 37% and MI made up 22% of deaths.

    “Among the causes of death, they reported that cardiovascular-related causes made up 37% and MI made up 22%198).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [198] 199) Kioka Y, Tanabe A, Kotani Y, Yamada N, Nakahama M, Ueda T, Seitou T, Maruyama M. Review of coronary artery disease in patients with infrarenal abdominal aortic aneurysm. Circ J, 2002; 66: 1110-1112 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the REACH Registry, among 603 Japanese individuals with coexisting PAD, the incidence of CVD within 1 year was 1.25% for all deaths, 0.55% for cardiovascular death, 0.77% for nonfatal MI, and 1.56% for nonfatal stroke.

    “The resulting incidence rates were generally high - 1.25% for all deaths, 0.55% for cardiovascular death, 0.77% for nonfatal MI, and 1.56% for nonfatal stroke184).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [184] 185) Goto S, Ikeda Y, Shimada K, Uchiyama S, Origasa H, Kobayashi H, J-TRACE Investigators. One-year cardiovascular event rates in Japanese outpatients with myocardial infarction, stroke, and atrial fibrillation. -results from the Japan Thrombosis Registry for Atrial Fibrillation, Coronary, or Cerebrovascular Events (J-TRACE). Circ J, 2011; 75: 2598-2604 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a prospective observational study of 557 patients with PAD by Shigematsu et al., the three-year incidence rate was 6.3% for cardiovascular death, 11.3% for heart disease, 7.0% for cerebrovascular disease and 16.9% for events in the lower extremities.

    “It was observed in the study that the three-year incidence rate was 6.3% for cardiovascular death, 11.3% for heart disease, 7.0% for cerebrovascular disease and 16.9% for events in the lower extremities193).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [193] 194) Hobbs SD, Claridge MW, Quick CR, Day NE, Brad-bury AW, Wilmink AB. LDL cholesterol is associated with small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2003; 26: 618-622 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Even though there are no longitudinal studies demonstrating AAA as a risk factor for ASCVD, there are some cross-sectional studies showing the association between AAA and ASCVD.

    “From these results, even though there are no longitudinal studies demonstrating AAA as a risk factor for ASCVD, there are some cross-sectional studies showing the association between AAA and ASCVD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    High LDL-C, high TC, hypertension, and smoking are factors that contribute to the development of AAA, and this is a commonality with ASCVD.

    “High LDL-C194), high TC195), hypertension196), and smoking are the factors that contribute to the development of AAA, and this is a commonality with ASCVD.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [194] 195) Tornwall ME, Virtamo J, Haukka JK, Albanes D, Huttunen JK. Life-style factors and risk for abdominal aortic aneurysm in a cohort of Finnish male smokers. Epidemiology, 2001; 12: 94-100 source

      Not checked in the free run.

    • cites [195] 196) Bhak RH, Wininger M, Johnson GR, Lederle FA, Messina LM, Ballard DJ, Wilson SE, Aneurysm Detection and Management (ADAM) Study Group. Factors associated with small abdominal aortic aneurysm expansion rate. JAMA Surg, 2015; 150: 44-50 source

      Not checked in the free run.

    • cites [196] 197) Akai A, Watanabe Y, Hoshina K, Obitsu Y, Deguchi J, Sato O, Shigematsu K, Miyata T. Family history of aortic aneurysm is an independent risk factor for more rapid growth of small abdominal aortic aneurysms in Japan. J Vasc Surg, 2015; 61: 287-290 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Uric acid level is an independent risk factor for the development of hypertension, stroke, and coronary events.

    “According to subsequent reports, including a meta-analysis, it has been revealed that uric acid level is an independent risk factor for the development of hypertension, stroke, and coronary events206–208).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [206] 207) Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and risk of stroke: A systematic review and meta-analysis. Arthritis Rheum, 2009; 61: 885-892 source

      Not checked in the free run.

    • cites [207] 208) Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and coronary heart disease: A systematic review and meta-analysis. Arthritis Care Res (Hoboken), 2010; 62: 170-180 source

      Not checked in the free run.

    • cites [208] 209) Zhang W, Iso H, Murakami Y, Miura K, Nagai M, Sugiyama D, Ueshima H, Okamura T, EPOCH-JAPAN GROUP. Serum uric acid and mortality form cardiovascular disease: EPOCH-JAPAN Study. J Atheroscler Thromb, 2016; 23: 692-703 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Serum uric acid levels can be regarded as an independent predictive factor for the development of hypertension.

    “it was mentioned that serum uric acid levels (1) can be regarded as an independent predictive factor for the development of hypertension”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [205] 206) Wang J, Qin T, Chen J, Li Y, Wang L, Huang H, Li J. Hyperuricemia and risk of incident hypertension: A systematic review and meta-analysis of observational studies. PLoS One, 2014; 9: e114259 source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    RAS is a progressive condition, and individuals with RAS have a tendency for worsened renal function.

    “RAS is a progressive condition, and individuals with RAS have a tendency for worsened renal function.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Conflicting reports on whether serum uric acid level is an independent risk factor for CVD have been produced.

    “At the same time, it was mentioned in the guideline that conflicting reports on whether serum uric acid level is an independent risk factor for CVD have been produced205).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [205] 206) Wang J, Qin T, Chen J, Li Y, Wang L, Huang H, Li J. Hyperuricemia and risk of incident hypertension: A systematic review and meta-analysis of observational studies. PLoS One, 2014; 9: e114259 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study of 788 Japanese patients (500 with AAA, 183 with PAD, 105 with both), myocardial ischemia was seen in 37% of patients with AAA, 55% with PAD, and 77% with both.

    “As a result, myocardial ischemia was seen in 37% the patients with AAA, 55% patients with PAD and 77% patients with both200).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [200] 201) Tollefson DF, Ernst CB. Natural history of atherosclerotic renal artery stenosis associated with aortic disease. J Vasc Surg, 1991; 14: 327-331 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Serum uric acid levels can possibly be a predictive factor for the risk of incipient stroke and recurrence, as well as for the re-hospitalization and prognosis caused by heart failure.

    “and (2) it can possibly be a predictive factor for the risk of incipient stroke and recurrence, as well as for the re-hospitalization and prognosis caused by heart failure.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [205] 206) Wang J, Qin T, Chen J, Li Y, Wang L, Huang H, Li J. Hyperuricemia and risk of incident hypertension: A systematic review and meta-analysis of observational studies. PLoS One, 2014; 9: e114259 source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Ninety five percent of renal artery stenosis (RAS) is caused by arteriosclerosis and it coexists with other forms of ASCVD at a high rate.

    “Ninety five percent of renal artery stenosis (RAS) is caused by arteriosclerosis and it coexists with other forms of ASCVD at a high rate.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Other forms of ASCVD, such as CAD and cerebrovascular disease, easily occur in PAD patients at high incidence rates, and this has also been clearly shown in Japan.

    “As mentioned above, other forms of ASCVD, such as CAD and cerebrovascular disease, easily occur in PAD patients at high incidence rates, and this has also been clearly shown in Japan.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The survival rate decreases with higher degrees of RAS.

    “and that the survival rate decreases with higher degrees of RAS204).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [204] 205) Yamanaka H, Japanese Society of Gout and Nucleic Acid Metabolism. Japanese guideline for the management of hyperuricemia and gout: Second edition. Nucleosides Nucleotides Nucleic Acids, 2011; 30: 1018-1029 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with OSA have lower endothelial function than those without OSA, in addition to increased stiffness of the blood vessels and high-sensitivity C-reactive protein level.

    “A meta-regression analysis has clearly shown that patients with OSA have lower endothelial function than those without OSA, in addition to increased stiffness of the blood vessels and high-sensitivity C-reactive protein level212).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [212] 213) Zhou M, Guo B, Wang Y, Yan D, Lin C, Shi Z. The association between obstructive sleep apnea and carotid intima-media thickness: A systematic review and metaanalysis. Angiology, 2017; 68: 575-583 source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    OSA is a common disease that is closely related to lifestyle habits and is strongly associated with ASCVD.

    “OSA is on the other hand, seen as a common disease that is closely related to lifestyle habits and is strongly associated with ASCVD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The TC/HDL-C ratio, non-HDL-C/HDL-C ratio, LDL-C/HDL-C ratio, and apo B/AI ratio are markers for ASCVD.

    “The TC/HDL-C ratio, non-HDL-C/HDL-C ratio, LDL-C/HDL-C ratio, and apo B/AI ratio are markers for ASCVD. (Evidence level: E-1a)”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [268] 269) Sniderman AD, Williams K, Contois JH, Monroe HM, McQueen MJ, de Graaf J, Furberg CD. A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein b as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes, 2011; 4: 337-345 source

      Not checked in the free run.

    • cites [273] 274) Kastelein JJ, van der Steeg WA, Holme I, Gaffney M, Cater NB, Barter P, Deedwania P, Olsson AG, Boekholdt SM, Demicco DA, Szarek M, LaRosa JC, Pedersen TR, Grundy SM, TNT Study Group; IDEAL Study Group. Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment. Circulation, 2008; 117: 3002-3009 source

      Not checked in the free run.

    • cites [274] 275) Ray KK, Cannon CP, Cairns R, Morrow DA, Ridker PM, Braunwald E. Prognostic utility of apoB/AI, total cholesterol/HDL, non-HDL cholesterol, or hs-CRP as predictors of clinical risk in patients receiving statin therapy after acute coronary syndromes: Results from PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol, 2009; 29: 424-430 source

      Not checked in the free run.

    • cites [275] 276) Hong LF, Yan XN, Fan Y, Wu Q, Luo SH, Yang B, Li JJ. Is the ratio of apoB/apoA-1 the best predictor for the severity of coronary artery lesions in chinese diabetics with stable angina pectoris? An assessment based on gensini scores. J Geriatr Cardiol, 2015; 12: 402-409

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the sub-analysis of MRFIT, the nonfasting TG level was as useful as, or even more useful than, the fasting TG level for the risk for CAD; a nonfasting TG level of ≥ 200 mg/dL indicates a high risk.

    “In the sub-analysis of MRFIT, the nonfasting TG level was as useful as, or even more useful than, the fasting TG level for the risk for CAD; a nonfasting TG level of ≥ 200 mg/dL indicates a high risk246).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [246] 247) Nordestgaard BG, Langsted A, Mora S, Kolovou G, Baum H, Bruckert E, Watts GF, Sypniewska G, Wiklund O, Boren J, Chapman MJ, Cobbaert C, Des-camps OS, von Eckardstein A, Kamstrup PR, Pulkki K, Kronenberg F, Remaley AT, Rifai N, Ros E, Langlois M, European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Joint Consensus Initiative. Author information. Fasting is not routinely required for determination of a lipid profile: Clinical and laboratory implications including flagging at desirable concentration cut-points-a joint consens source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The association between the levels of small dense LDL and CAD has been reported in numerous sources, and its relationship with PAD and aneurysms has also been demonstrated.

    “The association between the levels of small dense LDL and CAD has been reported in numerous sources251–256), and its relationship with PAD and aneurysms has also been demonstrated257, 258).”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [251] 252) St-Pierre AC, Cantin B, Dagenais GR, Mauriege P, Bernard PM, Despres JP, Lamarche B. Low-density lipoprotein subfractions and the long-term risk of ischemic heart disease in men: 13-year follow-up data from the Quebec Cardiovascular study. Arterioscler Thromb Vasc Biol, 2005; 25: 553-559 source

      Not checked in the free run.

    • cites [252] 253) Arsenault BJ, Lemieux I, Despres JP, Wareham NJ, Luben R, Kastelein JJ, Khaw KT, Boekholdt SM. Cholesterol levels in small LDL particles predict the risk of coronary heart disease in the epic-norfolk prospective population study. Eur Heart J, 2007; 28: 2770-2777 source

      Not checked in the free run.

    • cites [253] 254) El Harchaoui K, van der Steeg WA, Stroes ES, Kuivenhoven JA, Otvos JD, Wareham NJ, Hutten BA, Kastelein JJ, Khaw KT, Boekholdt SM. Value of lowdensity lipoprotein particle number and size as predictors of coronary artery disease in apparently healthy men and women: The EPIC…Norfolk prospective population study. J Am Coll Cardiol, 2007; 49: 547-553 source

      Not checked in the free run.

    • cites [254] 255) Austin MA, Rodriguez BL, McKnight B, McNeely MJ, Edwards KL, Curb JD, Sharp DS. Low-density lipoprotein particle size, triglycerides, and high-density lipoprotein cholesterol as risk factors for coronary heart disease in older Japanese-American men. Am J Cardiol, 2000; 86: 412-416 source

      Not checked in the free run.

    • cites [255] 256) Koba S, Hirano T, Ito Y, Tsunoda F, Yokota Y, Ban Y, Iso Y, Suzuki H, Katagiri T. Significance of small dense low-density lipoprotein-cholesterol concentrations in relation to the severity of coronary heart diseases. Atherosclerosis, 2006; 189: 206-214 source

      Not checked in the free run.

    • cites [256] 257) Rizzo M, Pernice V, Frasheri A, Berneis K. Atherogenic lipoprotein phenotype and LDL size and subclasses in patients with peripheral arterial disease. Atherosclerosis, 2008; 197: 237-241 source

      Not checked in the free run.

    • cites [257] 258) Rizzo M, Krayenbuhl PA, Pernice V, Frasheri A, Battista Rini G, Berneis K. LDL size and subclasses in patients with abdominal aortic aneurysm. Int J Cardiol, 2009; 134: 406-408 source

      Not checked in the free run.

    • cites [258] 259) Hirano T, Ito Y, Koba S, Toyoda M, Ikejiri A, Saegusa H, Yamazaki J, Yoshino G. Clinical significance of small dense low-density lipoprotein cholesterol levels determined by the simple precipitation method. Arterioscler Thromb Vasc Biol, 2004; 24: 558-563 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The risk starts increasing when the nonfasting TG level reaches 115 mg/dL, and at ≥ 167 mg/dL, the risk increases by ≥ 3 times.

    “The risk starts increasing when the nonfasting TG level reaches 115 mg/dL, and at ≥ 167 mg/dL, the risk increases by ≥ 3 times.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [88] 89) Satoh H, Nishino T, Tomita K, Tsutsui H. Fasting triglyceride is a significant risk factor for coronary artery disease in middle-aged Japanese men. Circ J, 2006; 70: 227-231 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Lp(a) is an independent risk factor for CAD and stroke.

    “Lp(a) is an independent risk factor for CAD and stroke.”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [221] 222) Kronenberg F, Utermann G. Lipoprotein (a): Resurrected by genetics. J Intern Med, 2013; 273: 6-30 source

      Not checked in the free run.

    • cites [222] 223) Dube JB, Boffa MB, Hegele RA, Koschinsky ML. Lipoprotein (a): More interesting than ever after 50 years. Curr Opin Lipidol, 2012; 23: 133-140 source

      Not checked in the free run.

    • cites [223] 224) Schaefer EJ, Lamon-Fava S, Jenner JL, McNamara JR, Ordovas JM, Davis CE, Abolafia JM, Lippel K, Levy RI. Lipoprotein (a) levels and risk of coronary heart disease in men. The lipid research clinics coronary primary prevention trial. JAMA, 1994; 271: 999-1003 source

      Not checked in the free run.

    • cites [224] 225) Bennet A, Di Angelantonio E, Erqou S, Eiriksdottir G, Sigurdsson G, Woodward M, Rumley A, Lowe GD, Danesh J, Gudnason V. Lipoprotein (a) levels and risk of future coronary heart disease: Large-scale prospective data. Arch Intern Med, 2008; 168: 598-608 source

      Not checked in the free run.

    • cites [225] 226) Erqou S, Kaptoge S, Perry PL, Di Angelantonio E, Thompson A, White IR, Marcovina SM, Collins R, Thompson SG, Danesh J, Emerging Risk Factors Collaboration. Lipoprotein (a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA, 2009; 302: 412-423 source

      Not checked in the free run.

    • cites [226] 227) Marcovina SM, Koschinsky ML. Evaluation of lipoprotein (a) as a prothrombotic factor: Progress from bench to bedside. Curr Opin Lipidol, 2003; 14: 361-366 source

      Not checked in the free run.

    • cites [227] 228) Clarke R, Peden JF, Hopewell JC, Kyriakou T, Goel A, Heath SC, Parish S, Barlera S, Franzosi MG, Rust S, Bennett D, Silveira A, Malarstig A, Green FR, Lathrop M, Gigante B, Leander K, de Faire U, Seedorf U, Hamsten A, Collins R, Watkins H, Farrall M, Consortium P. Genetic variants associated with lp (a) lipoprotein level and coronary disease. N Engl J Med, 2009; 361: 2518-2528 source

      Not checked in the free run.

    • cites [228] 229) Boffa MB, Koschinsky ML. Lipoprotein (a): Truly a direct prothrombotic factor in cardiovascular disease? J Lipid Res, 2016; 57: 745-757 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    High Lp(a) concentrations are found in patients with FH, and it is presumed that hyper-Lp(a)-lipoproteinemia further increases the risk for CVD in patients with FH.

    “High Lp(a) concentrations are found in patients with FH, and it is presumed that hyper-Lp (a)-lipoproteinemia further increases the risk for CVD in patients with FH222).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [222] 223) Dube JB, Boffa MB, Hegele RA, Koschinsky ML. Lipoprotein (a): More interesting than ever after 50 years. Curr Opin Lipidol, 2012; 23: 133-140 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    When the size of apolipoprotein (a) [apo(a)] is small, the concentration of Lp(a) is high, and there is a high risk of CVD.

    “When the size of apolipoprotein (a) [apo(a)] is small, the concentration of Lp(a) is high, and there is a high risk of CVD.”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [221] 222) Kronenberg F, Utermann G. Lipoprotein (a): Resurrected by genetics. J Intern Med, 2013; 273: 6-30 source

      Not checked in the free run.

    • cites [222] 223) Dube JB, Boffa MB, Hegele RA, Koschinsky ML. Lipoprotein (a): More interesting than ever after 50 years. Curr Opin Lipidol, 2012; 23: 133-140 source

      Not checked in the free run.

    • cites [223] 224) Schaefer EJ, Lamon-Fava S, Jenner JL, McNamara JR, Ordovas JM, Davis CE, Abolafia JM, Lippel K, Levy RI. Lipoprotein (a) levels and risk of coronary heart disease in men. The lipid research clinics coronary primary prevention trial. JAMA, 1994; 271: 999-1003 source

      Not checked in the free run.

    • cites [224] 225) Bennet A, Di Angelantonio E, Erqou S, Eiriksdottir G, Sigurdsson G, Woodward M, Rumley A, Lowe GD, Danesh J, Gudnason V. Lipoprotein (a) levels and risk of future coronary heart disease: Large-scale prospective data. Arch Intern Med, 2008; 168: 598-608 source

      Not checked in the free run.

    • cites [225] 226) Erqou S, Kaptoge S, Perry PL, Di Angelantonio E, Thompson A, White IR, Marcovina SM, Collins R, Thompson SG, Danesh J, Emerging Risk Factors Collaboration. Lipoprotein (a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA, 2009; 302: 412-423 source

      Not checked in the free run.

    • cites [226] 227) Marcovina SM, Koschinsky ML. Evaluation of lipoprotein (a) as a prothrombotic factor: Progress from bench to bedside. Curr Opin Lipidol, 2003; 14: 361-366 source

      Not checked in the free run.

    • cites [227] 228) Clarke R, Peden JF, Hopewell JC, Kyriakou T, Goel A, Heath SC, Parish S, Barlera S, Franzosi MG, Rust S, Bennett D, Silveira A, Malarstig A, Green FR, Lathrop M, Gigante B, Leander K, de Faire U, Seedorf U, Hamsten A, Collins R, Watkins H, Farrall M, Consortium P. Genetic variants associated with lp (a) lipoprotein level and coronary disease. N Engl J Med, 2009; 361: 2518-2528 source

      Not checked in the free run.

    • cites [228] 229) Boffa MB, Koschinsky ML. Lipoprotein (a): Truly a direct prothrombotic factor in cardiovascular disease? J Lipid Res, 2016; 57: 745-757 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    MDA-LDL is useful for prognostic prediction of the incidence of CAD and the recurrence of stenosis after percutaneous coronary intervention (PCI) in diabetic patients with a history of CAD.

    “MDALDL is useful for prognostic prediction of the incidence of CAD and the recurrence of stenosis after percutaneous coronary intervention (PCI) in diabetic patients with a history of CAD236).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [236] 237) Ito T, Fujita H, Tani T, Ohte N. Malondialdehyde-modified low-density lipoprotein is a predictor of cardiac events in patients with stable angina on lipid-lowering therapy after percutaneous coronary intervention using drug-eluting stent. Atherosclerosis, 2015; 239: 311-317 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    PTX-3 is expected to serve as a specific marker reflecting CVD in the future.

    “PTX-3 is expected to serve as a specific marker reflecting CVD in the future283–286).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [283] 284) Iwata A, Miura S, Tanaka T, Ike A, Sugihara M, Nishikawa H, Kawamura A, Saku K. Plasma pentraxin-3 levels are associated with coronary plaque vulnerability and are decreased by statin. Coron Artery Dis, 2012; 23: 315-321 source

      Not checked in the free run.

    • cites [284] 285) Hollan I, Nebuloni M, Bottazzi B, Mikkelsen K, Forre OT, Almdahl SM, Mantovani A, Fagerland MW, Auk-rust P, Meroni PL, Feiring Heart Biopsy Study Group. Pentraxin 3, a novel cardiovascular biomarker, is expressed in aortic specimens of patients with coronary artery disease with and without rheumatoid arthritis. Cardiovasc Pathol, 2013; 22: 324-331 source

      Not checked in the free run.

    • cites [285] 286) Yasunaga T, Ikeda S, Koga S, Nakata T, Yoshida T, Masuda N, Kohno S, Maemura K. Plasma pentraxin 3 is a more potent predictor of endothelial dysfunction than high-sensitive c-reactive protein. Int Heart J, 2014; 55: 160-164 source

      Not checked in the free run.

    • cites [286] 287) Gerhard GT, Duell PB. Homocysteine and atherosclerosis. Curr Opin Lipidol, 1999; 10: 417-428 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The association of CRP and PTX-3 in coronary artery plaques in pathological autopsies shows that both CRP and PTX-3 reflect unstable plaques.

    “Recent reports have suggested that the association of CRP and PTX-3 in coronary artery plaques in pathological autopsies shows that both CRP and PTX-3 reflect unstable plaques.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [283] 284) Iwata A, Miura S, Tanaka T, Ike A, Sugihara M, Nishikawa H, Kawamura A, Saku K. Plasma pentraxin-3 levels are associated with coronary plaque vulnerability and are decreased by statin. Coron Artery Dis, 2012; 23: 315-321 source

      Not checked in the free run.

    • cites [284] 285) Hollan I, Nebuloni M, Bottazzi B, Mikkelsen K, Forre OT, Almdahl SM, Mantovani A, Fagerland MW, Auk-rust P, Meroni PL, Feiring Heart Biopsy Study Group. Pentraxin 3, a novel cardiovascular biomarker, is expressed in aortic specimens of patients with coronary artery disease with and without rheumatoid arthritis. Cardiovasc Pathol, 2013; 22: 324-331 source

      Not checked in the free run.

    • cites [285] 286) Yasunaga T, Ikeda S, Koga S, Nakata T, Yoshida T, Masuda N, Kohno S, Maemura K. Plasma pentraxin 3 is a more potent predictor of endothelial dysfunction than high-sensitive c-reactive protein. Int Heart J, 2014; 55: 160-164 source

      Not checked in the free run.

    • cites [286] 287) Gerhard GT, Duell PB. Homocysteine and atherosclerosis. Curr Opin Lipidol, 1999; 10: 417-428 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    hs-CRP has been associated with the onset risk of MI and stroke, of which the association is particularly strong in MI.

    “hs-CRP has also been associated with the onset risk of MI and stroke, of which the association is particularly strong in MI281).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [281] 282) Wensley F, Gao P, Burgess S, Kaptoge S, Di Angelantonio E, Shah T, Engert JC, Clarke R, Davey-Smith G, Nordestgaard BG, Saleheen D, Samani NJ, Sandhu M, Anand S, Pepys MB, Smeeth L, Whittaker J, Casas JP, Thompson SG, Hingorani AD, Danesh J, C Reactive Protein Coronary Heart Disease Genetics Collaboration (CCGC). Association between c reactive protein and coronary heart disease: Mendelian randomisation analysis based on individual participant data. BMJ, 2011; 342: d548 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The apo B/AI ratio was strongly involved in coronary atherosclerosis; however, the significance disappeared after adjustment for confounding factors.

    “The apo B/AI ratio, in particular, was strongly involved in the coronary atherosclerosis; however, the significance disappeared after adjustment for confounding factors276).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [276] 277) Hisamatsu T, Fujiyoshi A, Miura K, Ohkubo T, Kadota A, Kadowaki S, Kadowaki T, Yamamoto T, Miyagawa N, Zaid M, Torii S, Takashima N, Murakami Y, Okamura T, Horie M, Ueshima H, SESSA Research Group. Lipoprotein particle profiles compared with standard lipids in association with coronary artery calcification in the general Japanese population. Atherosclerosis, 2014; 236: 237-243 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Small dense LDL is more strongly associated with the risk for CAD, the severity of coronary atherosclerosis, and the incidence of ASCVD in secondary prevention than is LDL-C among Japanese populations.

    “In addition, small dense LDL is more strongly associated with the risk for CAD259), the severity of coronary atherosclerosis256, 260), and the incidence of ASCVD in secondary prevention261) than is LDL-C among Japanese populations.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [259] 260) Koba S, Yokota Y, Hirano T, Ito Y, Ban Y, Tsunoda F, Sato T, Shoji M, Suzuki H, Geshi E, Kobayashi Y, Katagiri T. Small LDL-cholesterol is superior to LDL-cholesterol for determining severe coronary atherosclerosis. J Atheroscler Thromb, 2008; 15: 250-260 source

      Not checked in the free run.

    • cites [256] 257) Rizzo M, Pernice V, Frasheri A, Berneis K. Atherogenic lipoprotein phenotype and LDL size and subclasses in patients with peripheral arterial disease. Atherosclerosis, 2008; 197: 237-241 source

      Not checked in the free run.

    • cites [260] 261) Nishikura T, Koba S, Yokota Y, Hirano T, Tsunoda F, Shoji M, Hamazaki Y, Suzuki H, Itoh Y, Katagiri T, Kobayashi Y. Elevated small dense low-density lipoprotein cholesterol as a predictor for future cardiovascular events in patients with stable coronary artery disease. J Atheroscler Thromb, 2014; 21: 755-767 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The distributions of CRP and PTX-3 in the plaques are not the same, and there is a possibility that they play different roles.

    “However, the distributions of CRP and PTX-3 in the plaques are not the same, and there is a possibility that they play different roles.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [283] 284) Iwata A, Miura S, Tanaka T, Ike A, Sugihara M, Nishikawa H, Kawamura A, Saku K. Plasma pentraxin-3 levels are associated with coronary plaque vulnerability and are decreased by statin. Coron Artery Dis, 2012; 23: 315-321 source

      Not checked in the free run.

    • cites [284] 285) Hollan I, Nebuloni M, Bottazzi B, Mikkelsen K, Forre OT, Almdahl SM, Mantovani A, Fagerland MW, Auk-rust P, Meroni PL, Feiring Heart Biopsy Study Group. Pentraxin 3, a novel cardiovascular biomarker, is expressed in aortic specimens of patients with coronary artery disease with and without rheumatoid arthritis. Cardiovasc Pathol, 2013; 22: 324-331 source

      Not checked in the free run.

    • cites [285] 286) Yasunaga T, Ikeda S, Koga S, Nakata T, Yoshida T, Masuda N, Kohno S, Maemura K. Plasma pentraxin 3 is a more potent predictor of endothelial dysfunction than high-sensitive c-reactive protein. Int Heart J, 2014; 55: 160-164 source

      Not checked in the free run.

    • cites [286] 287) Gerhard GT, Duell PB. Homocysteine and atherosclerosis. Curr Opin Lipidol, 1999; 10: 417-428 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ratio of different cholesterols and the ratio of different apolipoproteins contained in each lipoprotein are risk factors for ASCVD.

    “However, rather than the levels of these lipids and apolipoproteins, the ratio of different cholesterols and the ratio of different apolipoproteins contained in each lipoprotein are risk factors for ASCVD.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [268] 269) Sniderman AD, Williams K, Contois JH, Monroe HM, McQueen MJ, de Graaf J, Furberg CD. A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein b as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes, 2011; 4: 337-345 source

      Not checked in the free run.

    • cites [273] 274) Kastelein JJ, van der Steeg WA, Holme I, Gaffney M, Cater NB, Barter P, Deedwania P, Olsson AG, Boekholdt SM, Demicco DA, Szarek M, LaRosa JC, Pedersen TR, Grundy SM, TNT Study Group; IDEAL Study Group. Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment. Circulation, 2008; 117: 3002-3009 source

      Not checked in the free run.

    • cites [274] 275) Ray KK, Cannon CP, Cairns R, Morrow DA, Ridker PM, Braunwald E. Prognostic utility of apoB/AI, total cholesterol/HDL, non-HDL cholesterol, or hs-CRP as predictors of clinical risk in patients receiving statin therapy after acute coronary syndromes: Results from PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol, 2009; 29: 424-430 source

      Not checked in the free run.

    • cites [275] 276) Hong LF, Yan XN, Fan Y, Wu Q, Luo SH, Yang B, Li JJ. Is the ratio of apoB/apoA-1 the best predictor for the severity of coronary artery lesions in chinese diabetics with stable angina pectoris? An assessment based on gensini scores. J Geriatr Cardiol, 2015; 12: 402-409

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The concentration of CRP is probably not a cause of ASCVD but instead reflects the extent to which atherosclerosis has progressed.

    “This result suggests that the concentration of CRP is probably not a cause of ASCVD but instead reflects the extent to which atherosclerosis has progressed.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Metabolic syndrome is recognized as a condition in which the risk factors of atherosclerosis cluster on the basis of obesity, particularly visceral fat accumulation, due to overnutrition and physical inactivity.

    “Metabolic syndrome is recognized as a condition in which the risk factors of atherosclerosis cluster on the basis of obesity, particularly visceral fat accumulation, due to overnutrition and physical inactivity312, 313).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [312] 313) Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet, 2005; 366: 1059-1062 source

      Not checked in the free run.

    • cites [313] 314) Nakamura T, Tsubono Y, Kameda-Takemura K, Funahashi T, Yamashita S, Hisamichi S, Kita T, Yamamura T, Matsuzawa Y, Group of the Research for the Association between Host Origin and Atherosclerotic Diseases under the Preventive Measure for Work-related Diseases of the Japanese Labor Ministry. Magnitude of sustained multiple risk factors for ischemic heart disease in Japanese employees: A case-control study. Jpn Circ J, 2001; 65: 11-17 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although PAI-1 activity was decreased at the time of discharge at approximately 1 month later, the levels were still higher in patients with acute MI than in the control group.

    “Sakamoto et al. have shown that although its activity was decreased at the time of discharge at approximately 1 month later, the levels were still higher in patients with acute MI than in the control group302).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [302] 303) Hoekstra T, Geleijnse JM, Schouten EG, Kluft C. Plasminogen activator inhibitor-type 1: Its plasma determinants and relation with cardiovascular risk. Thromb Haemost, 2004; 91: 861-872 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    PAI-1 is associated with ASCVD and metabolic syndrome, which involves an accumulation of visceral fats and insulin resistance.

    “Reports have demonstrated that PAI-1 is associated with ASCVD and metabolic syndrome, which involves an accumulation of visceral fats and insulin resistance303).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [303] 304) Nikolopoulos GK, Bagos PG, Tsangaris I, Tsiara CG, Kopterides P, Vaiopoulos A, Kapsimali V, Bonovas S, Tsantes AE. The association between plasminogen activator inhibitor type 1 (PAI-1) levels, PAI-1 4g/5g polymorphism, and myocardial infarction: A mendelian randomization meta-analysis. Clin Chem Lab Med, 2014; 52: 937-950 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The risk may possibly increase further depending on the genotypes that exist for PAI-1.

    “The risk may possibly increase further depending on the genotypes that exist for PAI-1304, 305).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [304] 305 Tsantes AE, Nikolopoulos GK, Bagos PG, Tsiara CG, Kapsimali V, Travlou A, Vaiopoulos G. Plasminogen activator inhibitor-1 4g/5g polymorphism and risk of ischemic stroke: A meta-analysis. Blood Coagul Fibrinolysis, 2007; 18: 497-504 source

      Not checked in the free run.

    • cites [305] 306) Ministry of Health, Labour and Welfare. National health and nutrition survey in Japan, 2014. 2016 https://www.mhlw.go.jp/bunya/kenkou/eiyou/dl/ h26-houkoku.pdf (in Japanese)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a 10-year follow-up study of middle-aged and elderly Japanese-American men, approximately 30% of subjects developed CAD and the accumulation of visceral fat, hypertension, and hyperglycemia were important risk factors.

    “A 10-year follow-up study of middleaged and elderly Japanese-American men revealed that approximately 30% of subjects developed CAD and that the accumulation of visceral fat, hypertension, and hyperglycemia were important risk factors322).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [322] 323) Malik S, Wong ND, Franklin SS, Kamath TV, L’Italien GJ, Pio JR, Williams GR. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation, 2004; 110: 1245-1250 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both CRP and fibrinogen are risk factors for primary cardiovascular disease.

    “The conclusion of an integrated analysis of 52 prospective studies was that both CRP and fibrinogen are risk factors for primary cardiovascular disease278).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [278] 279) Kawase Ishihara K, Kokubo Y, Yokota C, Hida E, Miyata T, Toyoda K, Matsumoto M, Minematsu K, Miyamoto Y. Effect of plasma fibrinogen, high-sensitive c-reactive protein, and cigarette smoking on carotid atherosclerosis: The Suita Study. J Stroke Cerebrovasc Dis, 2015; 24: 2385-2389 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Homocysteine is a stronger marker than is CRP.

    “Furthermore, analyses in the recent years have suggested that homocysteine is a stronger marker than is CRP291).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [291] 292) Lewis SJ, Ebrahim S, Davey Smith G. Meta-analysis of mthfr 677c-&gt;t polymorphism and coronary heart disease: Does totality of evidence support causal role for homocysteine and preventive potential of folate? BMJ, 2005; 331: 1053 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Visceral fat accumulation was not considered a necessary condition in this criteria.

    “Visceral fat accumulation was not considered a necessary condition in this criteria.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [329] 330) Hiuge-Shimizu A, Kishida K, Funahashi T, Ishizaka Y, Oka R, Okada M, Suzuki S, Takaya N, Nakagawa T, Fukui T, Fukuda H, Watanabe N, Yoshizumi T, Nakamura T, Matsuzawa Y, Yamakado M, Shimomura I. Absolute value of visceral fat area measured on computed tomography scans and obesity-related cardiovascular risk factors in large-scale Japanese general population (the VACATION-J study). Ann Med, 2012; 44: 82-92 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    European and American scientific societies issued a joint declaration later proposing that an individual with three out of the five risk factors - visceral obesity, hypertriglyceridemia, hypo-HDL cholesterolemia, high BP reading, and high glucose level - can be diagnosed as metabolic syndrome.

    “However, European and American scientific societies issued a joint declaration later proposing that an individual with three out of the five risk factors - visceral obesity, hypertriglyceridemia, hypo-HDL cholesterolemia, high BP reading, and high glucose level - can be diagnosed as metabolic syndrome329).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [329] 330) Hiuge-Shimizu A, Kishida K, Funahashi T, Ishizaka Y, Oka R, Okada M, Suzuki S, Takaya N, Nakagawa T, Fukui T, Fukuda H, Watanabe N, Yoshizumi T, Nakamura T, Matsuzawa Y, Yamakado M, Shimomura I. Absolute value of visceral fat area measured on computed tomography scans and obesity-related cardiovascular risk factors in large-scale Japanese general population (the VACATION-J study). Ann Med, 2012; 44: 82-92 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    Visceral fat accumulation is required for the diagnostic criteria in Japan, and the aim is to solve the integration of risk factors through the interventions to reduce visceral fat.

    “Visceral fat accumulation is required for the diagnostic criteria in Japan, and the aim is to solve the integration of risk factors through the interventions to reduce visceral fat.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Hypertension, diabetes, and smoking are regarded as predictive factors for ASCVD.

    “Hypertension, diabetes, and smoking are regarded as predictive factor for ASCVD.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Nine articles published between January 01, 1990 and September 30, 2016 were selected for this review and are summarized in Table 6.

    “Nine articles published between January 01, 1990 and September 30, 2016161, 162, 334–340) were selected for this review and are summarized in Table 6.”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [161] 162) Nishimura K, Okamura T, Watanabe M, Nakai M, Takegami M, Higashiyama A, Kokubo Y, Okayama A, Miyamoto Y. Predicting coronary heart disease using risk factor categories for a Japanese urban population, and comparison with the Framingham risk score: The Suita study. J Atheroscler Thromb, 2014; 21: 784-798 source

      Not checked in the free run.

    • cites [162] 163) Rumana N, Kita Y, Turin TC, Murakami Y, Sugihara H, Morita Y, Tomioka N, Okayama A, Nakamura Y, Abbott RD, Ueshima H. Trend of increase in the incidence of acute myocardial infarction in a Japanese population: Takashima AMI registry, 1990-2001. Am J Epidemiol, 2008; 167: 1358-1364 source

      Not checked in the free run.

    • cites [334] 335) Matsumoto M, Ishikawa S, Kayaba K, Gotoh T, Nago N, Tsutsumi A, Kajii E, Jichi Medical School (JMS) Cohort Study Group. Risk charts illustrating the 10-year risk of myocardial infarction among residents of Japanese rural communities: The JMS cohort study. J Epidemiol, 2009; 19: 94-100 source

      Not checked in the free run.

    • cites [335] 336) Ishikawa S, Matsumoto M, Kayaba K, Gotoh T, Nago N, Tsutsumi A, Kajii E, Jichi Medical School (JMS) Cohort Study Group. Risk charts illustrating the 10-year risk of stroke among residents of Japanese rural communities: The JMS cohort study. J Epidemiol, 2009; 19: 101-106 source

      Not checked in the free run.

    • cites [336] 337) Tanabe N, Iso H, Okada K, Nakamura Y, Harada A, Ohashi Y, Ando T, Ueshima H, Japan Arteriosclerosis Longitudinal Study Group. Serum total and non-highdensity lipoprotein cholesterol and the risk prediction of cardiovascular events - the JALS-ECC -. Circ J, 2010; 74: 1346-1356 source

      Not checked in the free run.

    • cites [337] 338) Noda H, Iso H, Sairenchi T, Irie F, Fukasawa N, Toriyama Y, Ota H, Nose T. Prediction of stroke, coronary heart disease, cardiovascular disease, cancer, and total death based on results of annual health checkups. Nihon Koshu Eisei Zasshi, 2006: 265-276 (in Japanese)

      Not checked in the free run.

    • cites [338] 339) Yatsuya H, Iso H, Yamagishi K, Kokubo Y, Saito I, Suzuki K, Sawada N, Inoue M, Tsugane S. Development of a point-based prediction model for the incidence of total stroke: Japan public health center study. Stroke, 2013; 44: 1295-1302 source

      Not checked in the free run.

    • cites [339] 340) Yatsuya H, Iso H, Li Y, Yamagishi K, Kokubo Y, Saito I, Sawada N, Inoue M, Tsugane S. Development of a risk equation for the incidence of coronary artery disease and ischemic stroke for middle-aged Japanese - Japan Public Health Center-Based Prospective Study. Circ J, 2016; 80: 1386-1395 source

      Not checked in the free run.

    • cites [340] 341) Nakai M, Miyamoto Y, Higashiyama A, Murakami Y, Nishimura K, Yatsuya H, Saitoh S, Sakata K, Iso H, Miura K, Ueshima H, Okamura T, EPOCH-JAPAN Research Group. Calibration between the estimated probability of the risk assessment chart of Japan atherosclerosis society and actual mortality using external population: Evidence for cardiovascular prevention from observational cohorts in Japan (EPOCH-JAPAN). J Atheroscler Thromb, 2016; 23: 176-195 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 2013 ACC/AHA guidelines include a new pooled cohort ASCVD risk equation to assess absolute risk.

    “The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines include a new pooled cohort ASCVD risk equation to assess absolute risk333).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [333] 334) Arima H, Yonemoto K, Doi Y, Ninomiya T, Hata J, Tanizaki Y, Fukuhara M, Matsumura K, Iida M, Kiyohara Y. Development and validation of a cardiovascular risk prediction model for Japanese: The Hisayama study. Hypertens Res, 2009; 32: 1119-1122 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    We performed a systematic review to answer CQ1: 'Are there any assessment tool that predict the ASCVD incidence and mortality in the Japanese?'

    “We performed a systematic review to answer CQ1: “Are there any assessment tool that predict the ASCVD incidence and mortality in the Japanese?””
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Since 2008, the measurement of waist circumference has been made compulsory in specific medical examinations and occupational health examinations, with the intent to prevent diabetes and atherosclerotic cardiovascular disease based on the concept of metabolic syndrome.

    “Since 2008, the measurement of waist circumference has been made compulsory in specific medical examinations and occupational health examinations, with the intent to prevent diabetes and atherosclerotic cardiovascular disease based on the concept of metabolic syndrome.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the diagnostic criteria, waist circumference is used as an index of visceral fat accumulation for practical convenience, and individuals with metabolic syndrome are defined as those having visceral fat accumulation demonstrated by increased waist circumference and 2 or more risk factors.

    “In the diagnostic criteria, waist circumference is used as an index of visceral fat accumulation for practical convenience, and individuals with metabolic syndrome are defined as those having visceral fat accumulation demonstrated by increased waist circumference and 2 or more risk factors312).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [312] 313) Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet, 2005; 366: 1059-1062 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The International Diabetes Federation also published similar diagnostic criteria.

    “The International Diabetes Federation also published similar diagnostic criteria313).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [313] 314) Nakamura T, Tsubono Y, Kameda-Takemura K, Funahashi T, Yamashita S, Hisamichi S, Kita T, Yamamura T, Matsuzawa Y, Group of the Research for the Association between Host Origin and Atherosclerotic Diseases under the Preventive Measure for Work-related Diseases of the Japanese Labor Ministry. Magnitude of sustained multiple risk factors for ischemic heart disease in Japanese employees: A case-control study. Jpn Circ J, 2001; 65: 11-17 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    It did not include individuals treated for secondary prevention or studies only consisted of patients with dyslipidemia.

    “It did not include individuals treated for secondary prevention or studies only consisted of patients with dyslipidemia.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The NIPPON DATA80 Risk Chart was used in the 2012 JAS Guidelines to estimate absolute risk.

    “The NIPPON DATA80 Risk Chart161) was used in the 2012 Japanese Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases to estimate absolute risk.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [161] 162) Nishimura K, Okamura T, Watanabe M, Nakai M, Takegami M, Higashiyama A, Kokubo Y, Okayama A, Miyamoto Y. Predicting coronary heart disease using risk factor categories for a Japanese urban population, and comparison with the Framingham risk score: The Suita study. J Atheroscler Thromb, 2014; 21: 784-798 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Western criteria of waist circumferences are merely based on the value corresponding to the obesity criteria in each country.

    “On the other hand, Western criteria of waist circumferences are merely based on the value corresponding to the obesity criteria in each country.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The definition of metabolic syndrome in Japan, characterized by accumulation of visceral fat accompanied by concurrence of multiple risk factors including elevated blood pressure, dyslipidemia, and hyperglycemia, was established in 2005.

    “The definition of metabolic syndrome in Japan, which is characterized by the accumulation of visceral fat accompanied by the concurrence of multiple risk factors including elevated blood pressure, dyslipidemia, and hyperglycemia, was established in 2005 (Table 5).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [312] 313) Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet, 2005; 366: 1059-1062 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The threshold of each risk grade cannot be determined statistically by using the absolute risk; the criteria were based on clinical consensus and social conventions.

    “As the threshold of each risk grade cannot be determined statistically by using the absolute risk, the criteria were based on clinical consensus and social conventions.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The threshold of each risk grade cannot be determined statistically by using the absolute risk; the criteria were based on clinical consensus and social conventions.

  • May combine two claims.

    Premisenone given

    Large clinical studies conducted in Western countries have shown that lowering the mean pretreatment LDL-C level decreases the risk of recurrence and total mortality of CAD and it is also effective in decreasing stroke incidence.

    “Large clinical studies conducted in Western countries have shown that lowering the mean pretreatment LDL-C level decreases the risk of recurrence and total mortality of CAD and it is also effective in decreasing stroke incidence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The incidence of CAD is likely to be higher in the Suita study than in other regional cohort studies and it differs from many other regional cohort studies in the use of coronary intervention as one of outcomes.

    “The incidence of CAD is likely to be higher in the Suita study than in other regional cohort studies and it differs from many other regional cohort studies in the use of coronary intervention as one of outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The estimated absolute risk is low in young people even with multiple risk factors and high in older individuals even with few risk factors.

    “This means that the estimated absolute risk is low in young people even with multiple risk factors and high in older individuals even with few risk factors.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    For consistency with the absolute risk assessment by NIPPON DATA80 used in the 2012 guidelines, the absolute risk of CAD is classified by scores ≤40 as low (a 10-year probability of CAD incidence of <2%), 41-55 as moderate (2-8%), or ≥56 as high (≥9%).

    “For consistency with the absolute risk assessment by NIPPON DATA80 used in the 2012 guidelines, the absolute risk of CAD is classified by scores ≤ 40 as low (a 10-year probability of CAD incidence of < 2%), 41–55 as moderate (2–8%), or ≥ 56 as high (≥ 9%).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Our society's guidelines must maintain continuity and consistency with the risk categorization used in our guidelines before.

  • May combine two claims.

    Interpretationcitation

    It is suggested that discontinuing smoking surpasses the disadvantages caused by weight gain and reduce the risk of CVD.

    “it is suggested that discontinuing smoking surpasses the disadvantages caused by weight gain and reduce the risk of CVD361).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [361] 362) Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjostrom L. Distribution of adipose tissue and risk of cardiovascular disease and death: A 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J (Clin Res Ed), 1984; 289: 1257-1261 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Lack of physical activity is associated with increased body fat (obesity), dyslipidemia, metabolic syndrome, hypertension, diabetes/impaired glucose tolerance, vascular endothelial dysfunction, and decreased physical fitness.

    “Lack of physical activity is associated with increased body fat (obesity), dyslipidemia, metabolic syndrome, hypertension, diabetes/impaired glucose tolerance, vascular endothelial dysfunction, and decreased physical fitness.”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [577] 579) Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. Physical activity and the risk of type 2 diabetes: A systematic review and dose-response meta-analysis. Eur J Epidemiol, 2015; 30: 529-542 source

      Not checked in the free run.

    • cites [578] 580) Hsieh SD, Yoshinaga H, Muto T, Sakurai Y. Regular physical activity and coronary risk factors in Japanese men. Circulation, 1998; 97: 661-665 source

      Not checked in the free run.

    • cites [579] 581) Pandey A, Garg S, Khunger M, Darden D, Ayers C, Kumbhani DJ, Mayo HG, de Lemos JA, Berry JD. Dose-response relationship between physical activity and risk of heart failure: A meta-analysis. Circulation, 2015; 132: 1786-1794 source

      Not checked in the free run.

    • cites [580] 582) Lee IM, Paffenbarger RS. Preventing coronary heart disease: The role of physical activity. Phys Sportsmed, 2001; 29: 37-52 source

      Not checked in the free run.

    • cites [581] 583) Oguma Y, Shinoda-Tagawa T. Physical activity decreases cardiovascular disease risk in women: Review and metaanalysis. Am J Prev Med, 2004; 26: 407-418 source

      Not checked in the free run.

    • cites [582] 584) Froelicher VF, Myers JN. Exercise and the heart (4th ed.) W. B. Sanders Company, 2000

      Not checked in the free run.

    • cites [583] 585) Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: A meta-analysis. Stroke, 2003; 34: 2475-2481 source

      Not checked in the free run.

    • cites [584] 586) Wendel-Vos GC, Schuit AJ, Feskens EJ, Boshuizen HC, Verschuren WM, Saris WH, Kromhout D. Physical activity and stroke. A meta-analysis of observational data. Int J Epidemiol, 2004; 33: 787-798 source

      Not checked in the free run.

    • cites [585] 587) Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet, 2012; 380: 219-229 source

      Not checked in the free run.

    • cites [586] 588) Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011. Am J Prev Med, 2011; 41: 207-215 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    A low-salt Japanese dietary pattern with reduced fat on meat and animal fats and consumption of soy, fish, vegetables, seaweed, mushrooms, fruits, and unpolished grains is recommended for ASCVD prevention.

    “A low-salt Japanese dietary pattern with reduced fat on meat and animal fats such as beef tallow, lard, and butter and the consumption of a combination with soy, fish, vegetables, seaweed, mushrooms, fruits, and unpolished grains are recommended for ASCVD prevention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Maintaining an appropriate body weight is effective in improving serum lipid levels, and it is possible to prevent ASCVD by improving serum lipid levels.

    “Therefore, maintaining an appropriate body weight is effective in improving serum lipid levels, and it is possible to prevent ASCVD by improving serum lipid levels.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Eating vegetables first during meals suppresses the elevation of postprandial blood glucose, which can help in decreasing body weight.

    “Eating the vegetables first during meals suppresses the elevation of postprandial blood glucose, which can help in decreasing body weight576).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [576] 578) Brown T, Avenell A, Edmunds LD, Moore H, Whittaker V, Avery L, Summerbell C. Systematic review of long-term lifestyle interventions to prevent weight gain and morbidity in adults. Obes Rev, 2009; 10: 627-638 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    In an appropriate total energy intake, reduction of the amount of SFA or substituting with PUFA is effective in improving serum lipid levels and in preventing CAD.

    “In an appropriate total energy intake, reduction of the amount of SFA or substituting with PUFA is effective in improving serum lipid levels, and in preventing CAD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Increasing physical activity increases insulin sensitivity and glucose tolerance.

    “Increasing physical activity maintains or adds to physical fitness, improves serum lipid levels, decreases blood pressure, increases insulin sensitivity and glucose tolerance, improves vascular endothelial function, and decreases thrombosis risk591–593).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [591] 593) Lee KW, Lip GY. Effects of lifestyle on hemostasis, fibrinolysis, and platelet reactivity: A systematic review. Arch Intern Med, 2003; 163: 2368-2392 source

      Not checked in the free run.

    • cites [592] 594) Young J, Angevaren M, Rusted J, Tabet N. Aerobic exercise to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev, 2015: CD005381 source

      Not checked in the free run.

    • cites [593] 595) Angevaren M, Aufdemkampe G, Verhaar HJ, Aleman A, Vanhees L. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev, 2008: CD005381 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Lifestyle modification including body weight reduction has positive effects on ASCVD risk factors including serum lipid levels, which may in turn suppress ASCVD.

    “However, lifestyle modification including body weight reduction has positive effects on ASCVD risk factors including serum lipid levels, which may in turn suppress ASCVD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Although there is no direct evidence showing that limiting total energy intake and maintaining an appropriate body weight suppresses ASCVD, improvement in serum lipid levels by lifestyle modification including body weight reduction in response to diet therapy may prevent ASCVD.

    “Although there is no direct evidence showing that limiting total energy intake and maintaining an appropriate body weight suppresses ASCVD, improvement in serum lipid levels by lifestyle modification including body weight reduction in response to diet therapy may prevent ASCVD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Unaccustomed exercises carry a risk of musculoskeletal disorders, and strenuous exercise may add to the risk of sudden death and MI in patients with CVD.

    “Note that unaccustomed exercises carry a risk of musculoskeletal disorders, and in addition to bone and joint injury, strenuous exercise may add to the risk of sudden death and MI in patients with CVD617, 618).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [617] 619) Hosomi N, Nagai Y, Kohriyama T, Ohtsuki T, Aoki S, Nezu T, Maruyama H, Sunami N, Yokota C, Kitagawa K, Terayama Y, Takagi M, Ibayashi S, Nakamura M, Origasa H, Fukushima M, Mori E, Minematsu K, Uchiyama S, Shinohara Y, Yamaguchi T, Matsumoto M, J-STARS Collaborators. The Japan statin treatment against recurrent stroke (J-STARS): A multicenter, randomized, open-label, parallel-group study. EBioMedicine, 2015; 2: 1071-1078 source

      Not checked in the free run.

    • cites [618] 620) Mizuno K, Nakaya N, Ohashi Y, Tajima N, Kushiro T, Teramoto T, Uchiyama S, Nakamura H, MEGA Study Group. Usefulness of pravastatin in primary prevention of cardiovascular events in women: Analysis of the management of elevated cholesterol in the primary prevention group of adult Japanese (MEGA study). Circulation, 2008; 117: 494-502 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Increasing physical activity decreases mental stress and slows the decline in cognitive function.

    “It also decreases mental stress and slows the decline in cognitive function594, 595).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [594] 596) Paffenbarger RS, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med, 1986; 314: 605-613 source

      Not checked in the free run.

    • cites [595] 597) Kujala UM, Kaprio J, Sarna S, Koskenvuo M. Relationship of leisure-time physical activity and mortality: The Finnish twin cohort. JAMA, 1998; 279: 440-444 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Early initiation of LDL-C-lowering therapy decreased lifetime cumulative LDL-C, which may have made it possible to decrease the occurrence of cardiovascular events.

    “Long-term observational included in large clinical trials found that the early initiation of LDLC-lowering therapy decreased lifetime cumulative LDL-C, which may have made it possible to decrease the occurrence of cardiovascular events.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    In secondary prevention complicated with FH or ACS, stricter LDL-C management to achieve a level < 70 mg/dL can be considered appropriate.

    “Therefore, in secondary prevention complicated with FH or ACS, stricter LDL-C management to achieve a level < 70 mg/dL can be considered appropriate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Although the indications and efficacy of PCSK9 inhibitors have been established, the safety of long-term administration has not been validated.

    “Although the indications and efficacy of PCSK9 inhibitors have been established, the safety of long-term administration has not been validated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The maximum lomitapide dose alone decreases LDL-C by 30% and apo-B by 24% from pretreatment levels, whereas combination with ezetimibe decreases LDL-C by 46% and apo-B by 37%.

    “The maximum lomitapide dose alone decreases the LDL-C level by 30% and the apo-B level by 24% from pretreatment levels. In contrast, the combination with ezetimibe showed decreases of 46% and 37%, respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [685] 687) Fruchart JC, Brewer HB, Leitersdorf E. Consensus for the use of fibrates in the treatment of dyslipoproteinemia and coronary heart disease. Fibrate consensus group. Am J Cardiol, 1998; 81: 912-917

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    During lomitapide treatment, AST and ALT levels and liver fat content were significantly elevated, but these levels returned to normal in all patients 14 weeks after treatment cessation.

    “During lomitapide treatment, the AST and ALT levels were found to be significantly elevated, as was the liver fat content. However, these levels returned to normal in all patients 14 weeks after treatment cessation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [684] 686) Schoonjans K, Staels B, Auwerx J. Role of the peroxisome proliferator-activated receptor (PPAR) in mediating the effects of fibrates and fatty acids on gene expression. J Lipid Res, 1996; 37: 907-925 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Selective PPARα modulators such as pemafibrate are safer than conventional fibrates in combination with statins because they have few drug interactions with statins used in Japan and are not renally excreted.

    “Selective peroxisome proliferator-activated receptor α modulators (SPPARMα) (pemafibrate already approved in Japan) are considered to be safer than conventional fibrates in combination with statins because they have few drug interactions with the statins currently used in Japan and are not renally excreted.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    It has been suggested that a high statin dose, old age, small physical build, and female gender are risk factors for adverse reactions in Western countries.

    “Furthermore, although the doses are much different from those in Japan, it has been suggested that a high statin dose, old age, small physical build, and female gender are risk factors for adverse reactions in Western countries702–705).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [702] 704) Law M, Rudnicka AR. Statin safety: A systematic review. Am J Cardiol, 2006; 97: 52C-60C source

      Not checked in the free run.

    • cites [703] 705) Katz DH, Intwala SS, Stone NJ. Addressing statin adverse effects in the clinic: The 5 Ms. J Cardiovasc Pharmacol Ther, 2014; 19: 533-542 source

      Not checked in the free run.

    • cites [704] 706) Jacobson TA. Toward “Pain-free” Statin prescribing: Clinical algorithm for diagnosis and management of myalgia. Mayo Clin Proc, 2008; 83: 687-700 source

      Not checked in the free run.

    • cites [705] 707) Charles EC, Olson KL, Sandhoff BG, McClure DL, Merenich JA. Evaluation of cases of severe statin-related transaminitis within a large health maintenance organization. Am J Med, 2005; 118: 618-624 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Providing LDL-C-lowering therapy at an early stage following acute coronary syndrome is effective in suppressing cardiovascular events, and stricter LDL-C-lowering therapy suppresses cardiovascular events significantly more than conventional LDL-C-lowering therapy.

    “Meanwhile, it has been reported that providing LDL-C-lowering therapy at an early stage following ACS incidence is effective in suppressing cardiovascular events741), and that stricter LDL-C-lowering therapy suppresses cardiovascular events significantly more than conventional LDL-C-lowering therapy742).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [741] 743) Hulten E, Jackson JL, Douglas K, George S, Villines TC. The effect of early, intensive statin therapy on acute coronary syndrome: A meta-analysis of randomized controlled trials. Arch Intern Med, 2006; 166: 1814-1821 source

      Not checked in the free run.

    • cites [742] 744) Briel M, Schwartz GG, Thompson PL, de Lemos JA, Blazing MA, van Es GA, Kayikcioglu M, Arntz HR, den Hartog FR, Veeger NJ, Colivicchi F, Dupuis J, Okazaki S, Wright RS, Bucher HC, Nordmann AJ. Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes: A meta-analysis of randomized controlled trials. JAMA, 2006; 295: 2046-2056 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with early-incidence coronary artery disease are more likely to have familial hypercholesterolemia, and familial hypercholesterolemia patients have a higher risk of coronary artery disease recurrence than non-familial hypercholesterolemia patients.

    “However, based on the findings that patients with early-incidence CAD have are more likely to have FH735, 736), and that FH patients have a higher risk of CAD recurrence than non-FH patients737), it is recommended that the LDL-C level be controlled at a stricter level (as much as possible to LDL-C < 70 mg/dL) in FH patients738).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [735] 737) Nanchen D, Gencer B, Muller O, Auer R, Aghlmandi S, Heg D, Klingenberg R, Raber L, Carballo D, Carballo S, Matter CM, Luscher TF, Windecker S, Mach F, Rodondi N. Prognosis of patients with familial hypercholesterolemia after acute coronary syndromes. Circulation, 2016; 134: 698-709 source

      Not checked in the free run.

    • cites [736] 738) Santos RD, Gidding SS, Hegele RA, Cuchel MA, Barter PJ, Watts GF, Baum SJ, Catapano AL, Chapman MJ, Defesche JC, Folco E, Freiberger T, Genest J, Hovingh GK, Harada-Shiba M, Humphries SE, Jackson AS, Mata P, Moriarty PM, Raal FJ, Al-Rasadi K, Ray KK, Reiner Z, Sijbrands EJ, Yamashita S, International Atherosclerosis Society Severe Familial Hypercholesterolemia Panel. Defining severe familial hypercholesterolaemia and the implications for clinical management: A consensus statement from the international atherosclerosis society severe familial hypercholesterolemia panel. Lancet Diabetes End source

      Not checked in the free run.

    • cites [737] 739) Sato H, Kinjo K, Ito H, Hirayama A, Nanto S, Fukunami M, Nishino M, Lim YJ, Kijima Y, Koretsune Y, Nakatani D, Mizuno H, Shimizu M, Osaka Acute Coronary Insufficiency Study (OACIS)-LIPID Study Investigators. Effect of early use of low-dose pravastatin on major adverse cardiac events in patients with acute myocardial infarction: The OACIS-LIPID study. Circ J, 2008; 72: 17-22 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The risk for diabetes increases with statin use by 9-13%, but meta-analyses of large-scale RCTs suggest that the incidence frequency is low, approximately one to two cases per 1,000 patients per year.

    “Moreover, although it has been suggested that the risk for diabetes increases with statin use by 9–13%, meta-analyses of large-scale RCTs suggest that incidence frequency is low (approximately one to two cases per 1,000 patients per year)708–710).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [708] 710) Rajpathak SN, Kumbhani DJ, Crandall J, Barzilai N, Alderman M, Ridker PM. Statin therapy and risk of developing type 2 diabetes: A meta-analysis. Diabetes Care, 2009; 32: 1924-1929 source

      Not checked in the free run.

    • cites [709] 711) Ridker PM, Pradhan A, MacFadyen JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: An analysis from the JUPITER trial. Lancet, 2012; 380: 565-571 source

      Not checked in the free run.

    • cites [710] 712) Wiklund O, Pirazzi C, Romeo S. Monitoring of lipids, enzymes, and creatine kinase in patients on lipid-lowering drug therapy. Curr Cardiol Rep, 2013; 15: 397 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Observational studies have reported that LDL-C-lowering therapy using statins decreases cardiovascular event risk and delays the age of incidence of these events.

    “In addition, observational studies have reported that LDL-C-lowering therapy using statins decreases cardiovascular event risk733), and delays the age of incidence of these events734).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [733] 735) De Backer G, Besseling J, Chapman J, Hovingh GK, Kastelein JJ, Kotseva K, Ray K, Reiner ., Wood D, De Bacquer D, EUROASPIRE Investigators. Prevalence and management of familial hypercholesterolaemia in coronary patients: An analysis of EUROASPIRE IV, a study of the European Society of Cardiology. Atherosclerosis, 2015; 241: 169-175 source

      Not checked in the free run.

    • cites [734] 736) Rallidis LS, Triantafyllis AS, Tsirebolos G, Katsaras D, Rallidi M, Moutsatsou P, Lekakis J. Prevalence of heterozygous familial hypercholesterolaemia and its impact on long-term prognosis in patients with very early st-segment elevation myocardial infarction in the era of statins. Atherosclerosis, 2016; 249: 17-21 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients prescribed generic statins had better adherence rates and fewer composite endpoints such as hospitalization because of ACS and stroke, and all-cause mortality, than those prescribed name-brand statins.

    “It was found that patients who were prescribed generic statins not only had better adherence rates than those who were prescribed name-brand statins but also fewer composite endpoints such as hospitalization because of ACS and stroke, and all-cause mortality727).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [727] 729) Donnelly LA, Doney AS, Morris AD, Palmer CN, Don-nan PT. Long-term adherence to statin treatment in diabetes. Diabet Med, 2008; 25: 850-855 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Even in secondary prevention, the risk for cardiovascular events is high if familial hypercholesterolemia, acute coronary syndrome, diabetes mellitus, noncardiogenic cerebral infarction, peripheral arterial disease, chronic kidney disease, and metabolic syndrome are present, or if major risk factors overlap and smoking is present.

    “Even in secondary prevention, the risk for cardiovascular events is high if FH, ACS, DM, noncardiogenic cerebral infarction, PAD, CKD, and metabolic syndrome are present, or if there is an overlap in the major risk factors and the presence of smoking. (Evidence level: Ep-Ib)”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Caution should be taken when using fibrates and nicotinic acid derivatives in combination with statins because this can easily bring about liver and muscle adverse effects.

    “Caution should be taken when using fibrates and NA in combination with statins as this can easily bring about liver and muscle adverse effects712).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [712] 714) Omar MA, Wilson JP, Cox TS. Rhabdomyolysis and HMG-CoA reductase inhibitors. Ann Pharmacother, 2001; 35: 1096-1107 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The OACIS-LIPID study showed an incidence rate of 40 per 1,000 person-years for all-cause mortality and nonfatal myocardial infarction in the group that underwent lipid-lowering therapy using drugs other than statins, and 30 per 1,000 person-years for cardiovascular events in the group that received statins.

    “The study showed an incidence rate of 40/1,000 person-years for all-cause mortality and nonfatal myocardial infarction in the group that underwent lipid-lowering therapy using drugs other than statins. However, at 30/1,000 person-years, the incidence rate of cardiovascular events was also remarkably high in the group that received statins.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [739] 741) Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, Zeiher A, Chaitman BR, Leslie S, Stern T, Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: The MIRACL study: A randomized controlled trial. JAMA, 2001; 285: 1711-1718 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Regular blood testing after initiating drug therapy is likely to help build a good patient-physician relationship and inhibit cardiovascular events because of better drug adherence.

    “However, regular blood testing is likely to help build a good patient-physician relationship and inhibit cardiovascular events because of better drug adherence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The sub-analysis of JAPAN-ACS showed that the presence of diabetes posed a strong negative risk on plaque regression, and that even if LDL-C is controlled to the same extent as in nondiabetic patients, the rate of plaque regression in diabetic patients is markedly low.

    “The sub-analysis of JAPAN-ACS755), a study conducted in Japan involving patients with ACS, showed that the presence of diabetes posed a strong negative risk on plaque regression. Even if the LDL-C level is controlled to the same extent as that of nondiabetic patients, the rate of plaque regression in diabetic patients is markedly low.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [755] 757) Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, Goto S, Liau CS, Richard AJ, Rother J, Wilson PW, REACH Registry Investigators. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA, 2006; 295: 180-189 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Peripheral arterial disease is a high-risk condition for cardiovascular events in both Japan and the United States, though the complication rate of peripheral arterial disease was significantly higher in the United States.

    “In the comparison between the aforementioned database of the Texas Heart Association in the US and CREDO-Kyoto study in Japan, it was confirmed that PAD is a high-risk condition for cardiovascular event in both Japan and the US752), though the complication rate of PAD was significantly higher in the US.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [752] 754) Bayturan O, Kapadia S, Nicholls SJ, Tuzcu EM, Shao M, Uno K, Shreevatsa A, Lavoie AJ, Wolski K, Schoenhagen P, Nissen SE. Clinical predictors of plaque progression despite very low levels of low-density lipoprotein cholesterol. Journal of the American College of Cardiology, 2010; 55: 2736-2742 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    According to the observational CREDO-Kyoto study, the risk for cardiovascular death is 2.9-fold higher for post-PCI patients with chronic kidney disease, and the risk for total mortality increases by 2.1-fold.

    “In addition, according to the observational CREDO-Kyoto study, the risk for cardiovascular death is 2.9-fold higher for post-PCI patients with CKD, and the risk for total mortality increases by 2.1-fold183).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [183] 184) Uchiyama S, Goto S, Matsumoto M, Nagai R, Origasa H, Yamazaki T, Shigematsu H, Shimada K, Yamada N, Bhatt DL, Steg PG, Ikeda Y, REduction of Atherothrombosis for Continued Health Registry Investigators. Cardiovascular event rates in patients with cerebrovascular disease and atherothrombosis at other vascular locations: Results from 1-year outcomes in the Japanese REACH Registry. J Neurol Sci, 2009; 287: 45-51 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the ESTABLISH study, strict LDL-C-lowering therapy administered early after acute coronary syndrome decreased the average LDL-C level to 70 mg/dL after 6 months, resulting in a 13.1% decrease in plaque volume.

    “In the ESTABLISH study642), strict LDL-C-lowering therapy was administered early after ACS. The therapy decreased the average LDL-C level to 70 mg/dL after 6 months, which resulted in a 13.1% decrease in plaque volume.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [642] 644) Nakajima N, Miyauchi K, Yokoyama T, Ogita M, Miyazaki T, Tamura H, Nishino A, Yokoyama K, Okazaki S, Kurata T, Suwa S, Daida H. Effect of combination of ezetimibe and a statin on coronary plaque regression in patients with acute coronary syndrome: Zeus trial (Ezetimibe Ultrasound Study). IJC Metab Endocr, 2014; 3: 8-13 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with CAD who continue to smoke, total mortality, cardiac death, and sudden cardiac death risks are also significantly higher.

    “The total mortality, cardiac death, and sudden cardiac death risks are also significantly higher779–783).”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [779] 781) van Domburg RT, Meeter K, van Berkel DF, Veldkamp RF, van Herwerden LA, Bogers AJ. Smoking cessation reduces mortality after coronary artery bypass surgery: A 20-year follow-up study. J Am Coll Cardiol, 2000; 36: 878-883 source

      Not checked in the free run.

    • cites [780] 782) Rea TD, Heckbert SR, Kaplan RC, Smith NL, Lemaitre RN, Psaty BM. Smoking status and risk for recurrent coronary events after myocardial infarction. Ann Intern Med, 2002; 137: 494-500 source

      Not checked in the free run.

    • cites [781] 783) Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: Meta-analysis of cohort studies. Arch Intern Med, 2000; 160: 939-944 source

      Not checked in the free run.

    • cites [782] 784) Bhatt DL, Eagle KA, Ohman EM, Hirsch AT, Goto S, Mahoney EM, Wilson PW, Alberts MJ, D’Agostino R, Liau CS, Mas JL, Rother J, Smith SC, Salette G, Contant CF, Massaro JM, Steg PG, REACH Registry Investigators. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA, 2010; 304: 1350-1357 source

      Not checked in the free run.

    • cites [783] 785) Kinjo K, Sato H, Sakata Y, Nakatani D, Mizuno H, Shimizu M, Sasaki T, Kijima Y, Nishino M, Uematsu M, Tanouchi J, Nanto S, Otsu K, Hori M. Impact of smoking status on long-term mortality in patients with acute myocardial infarction. Circ J, 2005; 69: 7-12 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    LDL-C, HDL-C, HbA1c, and systolic blood pressure are risk factors for CAD, whereas hypertension, male gender, and atrial fibrillation are risk factors for cerebral infarction.

    “It has been reported that LDL-C, HDL-C, and HbA1c levels, as well as and systolic blood pressure are risk factors for CAD, whereas hypertension, male gender, and atrial fibrillation are risk factors for cerebral infarction789).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [789] 791) Murakami K, Ishibashi S, Yoshida Y, Yamada N, Akanuma Y. Lipoprotein (a) as a coronary risk factor in Japanese patients with Type II (non-insulin-dependent) diabetes mellitus. Relation with apolipoprotein (a) phenotypes. Diabetologia, 1998; 41: 1397-1398 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other Japanese studies have reported that smoking, male gender, and high Lp(a) are risk factors for CAD.

    “Other Japanese studies have reported that smoking, male gender, and high Lp(a)791) are risk factors for CAD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [791] 793) Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int, 2003; 63: 225-232 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that PCI follow-up study, statin administration resulted in a significant decrease in total mortality by 44% and in coronary death by 47%.

    “However, statin administration resulted in a significant decrease in total mortality by 44% and in coronary death by 47%778).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [778] 780) Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: A systematic review. JAMA, 2003; 290: 86-97 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The JDCS study conducted in Japan suggested that LDL-C and TG levels are risk factors for CAD, and that systolic blood pressure is a risk factor for stroke.

    “However, a study conducted in Japan (JDCS) has suggested that LDL-C and TG levels are risk factors for CAD, and that systolic blood pressure is a risk factor for stroke790).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [790] 792) Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, Halle JP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and non-diabetic individuals. JAMA, 2001; 286: 421-426 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a meta-analysis including CARDS, LDL-C-lowering therapy using statins greatly decreases CAD-related mortality, CVD, and cerebral infarction in diabetic patients.

    “In a meta-analysis including CARDS804), LDL-C-lowering therapy using statins greatly decreases CAD-related mortality, CVD, and cerebral infarction in diabetic patients.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [804] 806) Ginsberg HN, Elam MB, Lovato LC, Crouse JR, 3rd, Leiter LA, Linz P, Friedewald WT, Buse JB, Gerstein HC, Probstfield J, Grimm RH, Ismail-Beigi F, Bigger JT, Goff DC, Jr., Cushman WC, Simons-Morton DG, Byington RP. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med, 2010; 362: 1563-1574 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Compared to the cerebrovascular disease incidence in western countries, the cerebral hemorrhage incidence in Japan is higher whereas the cerebral infarction incidence is relatively low.

    “Compared to the cerebrovascular disease incidence in western countries, the cerebral hemorrhage incidence in Japan is higher whereas the cerebral infarction incidence is relatively low843).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [843] 846) Petty GW, Brown RD, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: A population-based study of incidence and risk factors. Stroke, 1999; 30: 2513-2516 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the Hisayama study, lacunar infarction accounted for approximately 50% cases of cerebral infarction, whereas the incidence rates of atherothrombotic cerebral infarction and cardiogenic cerebral embolism were just under 30% and just over 20%, respectively.

    “In the Hisayama study, lacunar infarction accounted for approximately 50% cases of cerebral infarction, whereas the incidence rates of atherothrombotic cerebral infarction and cardiogenic cerebral embolism were just under 30% and just over 20%, respectively844).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [844] 847) Lewington S, Whitlock G, Clarke R, Sherliker P, Ember-son J, Halsey J, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Blood cholesterol and vascular mortality by age, sex, and blood pressure: A metaanalysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet, 2007; 370: 1829-1839 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    According to the 2015 Stroke Data Bank, the cerebrovascular disease incidence in Japan is approximately 18.5% for cerebral hemorrhage, approximately 5.6% for subarachnoid hemorrhage, and 75.9% for cerebral infarction.

    “According to the 2015 Stroke Data Bank, the cerebrovascular disease incidence in Japan is reported to be approximately 18.5% for cerebral hemorrhage, approximately 5.6% for subarachnoid hemorrhage, and 75.9% for cerebral infarction842).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [842] 845) Kimura K, Kazui S, Minematsu K, Yamaguchi T. Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. A hospital-based prospective registration study. Cerebrovasc Dis, 2004; 18: 47-56 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Cholesterol level is recognized to be a risk factor only for atherothrombotic cerebral infarction, whereas hypertension is considered to be the major risk factor for all types of cerebral infarction, including atherothrombotic cerebral infarction.

    “Thus, cholesterol level is recognized to be a risk factor only for atherothrombotic cerebral infarction, whereas hypertension is considered to be the major risk factor for all types of cerebral infarction, including atherothrombotic cerebral infarction849).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [849] 852) Leppala JM, Virtamo J, Fogelholm R, Albanes D, Heinonen OP. Different risk factors for different stroke subtypes: Association of blood pressure, cholesterol, and antioxidants. Stroke, 1999; 30: 2535-2540 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The J-MUSIC study published in 2000 saw a 38.8% rate for lacunar infarction, a 33.3% rate for atherothrombotic cerebral infarction, and a 21.8% rate for cardiogenic cerebral embolism.

    “The J-MUSIC study published in 2,000 saw a change in the incidence rates, with a 38.8% rate for lacunar infarction, a 33.3% rate for atherothrombotic cerebral infarction, and a 21.8% rate for cardiogenic cerebral embolism845).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [845] 848) Blood pressure, cholesterol, and stroke in eastern Asia. Eastern stroke and coronary heart disease collaborative research group. Lancet, 1998; 352: 1801-1807 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the 2015 Stroke Data Bank, the dyslipidemia incidence in patients with noncardiogenic cerebral infarction is 40-50%, a number that has been increasing in recent years.

    “A study of the risk factors for noncardiogenic cerebral infarction only revealed that in the 2015 Stroke Data Bank, the dyslipidemia incidence in patients with noncardiogenic cerebral infarction is 40–50%, a number that has been increasing in recent years842).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [842] 845) Kimura K, Kazui S, Minematsu K, Yamaguchi T. Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. A hospital-based prospective registration study. Cerebrovasc Dis, 2004; 18: 47-56 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a meta-analysis of 21 large clinical trials by CTT Collaboration, stroke incidence is decreased by 15% and cerebral infarction incidence is decreased by 20% in patients with a decrease of 1 mmol/L (38.6 mg/dL) in the LDL-C level.

    “Similarly reported in the result from a meta-analysis of 21 large clinical trials by CTT Collaboration, stroke incidence is decreased by 15% and cerebral infarction incidence is decreased by 20% in patients with a decrease of 1 mmol/L (38.6 mg/dL) in the LDL-C level177).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [177] 178) Mihaylova B, Emberson J, Blackwell L, Keech A, Simes J, Barnes EH, Voysey M, Gray A, Collins R, Baigent C; Cholesterol Treatment Trialists’ (CTT) Collaboration. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: Meta-analysis of individual data from 27 randomised trials. Lancet, 2012; 380: 581-590 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the 2015 Stroke Data Bank, the incidence rate was 31.2% for lacunar infarction, 33.2% for atherothrombotic cerebral infarction, and 27.7% for cardiogenic cerebral embolism.

    “The numbers were also different in the 2015 Stroke Data Bank, with an incidence rate of 31.2% for lacunar infarction, 33.2% for atherothrombotic cerebral infarction, and 27.7% for cardiogenic cerebral embolism842).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [842] 845) Kimura K, Kazui S, Minematsu K, Yamaguchi T. Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. A hospital-based prospective registration study. Cerebrovasc Dis, 2004; 18: 47-56 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Some reports have stated that the TC level is either not a risk factor for cerebral infarction or has very little involvement.

    “On the contrary, some reports have stated that the TC level is either not a risk factor for cerebral infarction or has very little involvement855, 856).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [855] 858) Sturgeon JD, Folsom AR, Longstreth WT, Shahar E, Rosamond WD, Cushman M. Risk factors for intracerebral hemorrhage in a pooled prospective study. Stroke, 2007; 38: 2718-2725 source

      Not checked in the free run.

    • cites [856] 859) Soyama Y, Miura K, Morikawa Y, Nishijo M, Nakanishi Y, Naruse Y, Kagamimori S, Nakagawa H, Study O. High-density lipoprotein cholesterol and risk of stroke in Japanese men and women: The Oyabe study. Stroke, 2003; 34: 863-868 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A meta-analysis of 18 cohort studies in Japan and China showed that blood pressure is the most important risk factor for cerebrovascular disease, and that the TC level has much less involvement than blood pressure.

    “The results of a meta-analysis of 18 cohort studies in Japan and China showed that blood pressure is the most important risk factor for cerebrovascular disease, and that the TC level has much less involvement than blood pressure848).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [848] 851) Iso H, Jacobs DR, Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med, 1989; 320: 904-910 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cerebral infarction incidence in the western Caucasian population has been reported to be approximately 30% for both lacunar infarction and atherothrombotic cerebral infarction, and approximately 40% for cardiogenic cerebral embolism.

    “Cerebral infarction incidence in the western Caucasian population has been reported to be approximately 30% for both lacunar infarction and atherothrombotic cerebral infarction, and approximately 40% for cardiogenic cerebral embolism846).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [846] 849) Schneider AT, Kissela B, Woo D, Kleindorfer D, Alwell K, Miller R, Szaflarski J, Gebel J, Khoury J, Shukla R, Moomaw C, Pancioli A, Jauch E, Broderick J. Ischemic stroke subtypes: A population-based study of incidence rates among blacks and whites. Stroke, 2004; 35: 1552-1556 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A 3-5% reduction in body weight improves hypertension, DM, and dyslipidemia.

    “The aim of obesity management should be an improvement of hypertension, DM, and dyslipidemia by a 3–5% reduction in body weight369, 873).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [369] 370) Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ, Jordan HS, Kendall KA, Lux LJ, Mentor-Marcel R, Morgan LC, Trisolini MG, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC, Tomaselli GF, AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American source

      Not checked in the free run.

    • cites [873] 876) Fujiwara, H. Smoking cessation treatment covered by public health insurance: revisions to “Nicotine-addiction management fees” and smoking-cession treatment in the youth. Japanese Journal of Tobacco Control, 2016; 11: 3 (in Japanese)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the MEGA study, ischemic stroke incidence in men and stroke in women who were ≥ 55 years were significantly decreased.

    “In particular, ischemic stroke incidence in men and stroke in women who were ≥ 55 years were significantly decreased620, 621).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [620] 622) Tanaka K, Ishikawa Y, Yokoyama M, Origasa H, Matsuzaki M, Saito Y, Matsuzawa Y, Sasaki J, Oikawa S, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K, JELIS Investigators Japan. Reduction in the recurrence of stroke by eicosapentaenoic acid for hypercholesterolemic patients: Sub-analysis of the JELIS trial. Stroke, 2008; 39: 2052-2058 source

      Not checked in the free run.

    • cites [621] 623) Yusuf S, Bosch J, Dagenais G, Zhu J, Xavier D, Liu L, Pais P, Lopez-Jaramillo P, Leiter LA, Dans A, Avezum A, Piegas LS, Parkhomenko A, Keltai K, Keltai M, Sliwa K, Peters RJ, Held C, Chazova I, Yusoff K, Lewis BS, Jansky P, Khunti K, Toff WD, Reid CM, Varigos J, Sanchez-Vallejo G, McKelvie R, Pogue J, Jung H, Gao P, Diaz R, Lonn E, HOPE-3 Investigators. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med, 2016; 374: 2021-2031 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The serum uric acid level is a predictive factor for the future incidence of hypertension and is related to CKD incidence and progression.

    “The serum uric acid level is a predictive factor for the future incidence of hypertension and is related to CKD incidence and progression874).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [874] 877) Health and longevity management handbook. Essence of geriatrics for the general physician. Tokyo: Medical Review; 2012. (in Japanese)

      Not checked in the free run.

223 of 223

  • The paper relies on this without support.

    Major risk factors for ASCVD include diabetes, hypertension, smoking, and dyslipidemia (apart from age, gender, and family history).

    “Apart from age, gender, and family history, for which clinical intervention is not possible, the major risk factors for ASCVD include diabetes, hypertension, smoking, and dyslipidemia.”

  • The paper relies on this without support.

    Dyslipidemia is a huge risk factor for coronary artery disease (CAD).

    “Dyslipidemia is a huge risk factor for coronary artery disease (CAD), a form of ASCVD”

  • The paper relies on this without support.

    LDL-C is the major risk factor for ASCVD.

    “replacement of total cholesterol with LDL cholesterol (LDL-C) as the major risk factor were features of this guideline. Establishing LDL-C as the major risk factor has led to an even more direct approach toward managing the risk factors for ASCVD.”

  • The paper relies on this without support.

    The incidence of CAD is high when LDL-C or TG levels are high or when HDL-C level is low.

    “The incidence of CAD is high when the LDL-C or triglyceride (TG) levels are high or when the HDL-C level is low.”

  • The paper relies on this without support.

    Statin therapy is beneficial for prevention of ASCVD in Japan and overseas.

    “Given that statin therapy has been shown to be beneficial for prevention of ASCVD not just overseas but also in Japan”

  • The paper relies on this without support.

    Ezetimibe, PCSK9 inhibitors, and EPA are effective for prevention of ASCVD when used in combination with statins.

    “Ezetimibe, PCSK9 inhibitors, and EPA are the medications that have been proven to be effective for the prevention of ASCVD when used in combination with statins.”

  • The paper relies on this without support.

    Good adherence to medication leads to better efficacy for prevention of ASCVD.

    “good adherence has proven to lead to better efficacy for prevention of ASCVD.”

  • The paper relies on this without support.

    FH heterozygote exists in 1 of 200–500 individuals.

    “FH is a hereditary disease, and its heterozygote exists in 1 of 200–500 individuals.”

  • The paper relies on this without support.

    FH poses a high risk of CAD.

    “FH poses a high risk of CAD and is frequently encountered by general practitioners.”

  • The paper relies on this without support.

    The rate of diagnosis of FH in Japan is still low.

    “Because the rate of diagnosis in Japan is still low”

  • The paper relies on this without support.

    In elderly persons 65–74, high LDL-C is an important risk factor for CAD.

    “In the elderly persons 65–74 years of age, a high LDL-C level is an important risk factor for CAD”

  • The paper relies on this without support.

    The effect of statin therapy on CAD prevention and primary prevention of non-cardiogenic cerebral infarction is promising in elderly 65–74.

    “the effect of statin therapy on CAD prevention and primary prevention of non-cardiogenic cerebral infarction is promising.”

  • The paper relies on this without support.

    The effect of statin therapy on primary prevention in elderly ≥75 is not evident.

    “the effect of statin therapy on primary prevention in the elderly persons ≥ 75 years of age is not evident”

  • The paper relies on this without support.

    Diagnostic criteria for pediatric dyslipidemia, including FH, are different from adult cases.

    “the diagnostic criteria for pediatric cases of dyslipidemia, including FH, are different from those for adult cases.”

  • The paper relies on this without support.

    CT can diagnose arteriosclerosis in a short amount of time.

    “CT is a method of examination that can diagnose arteriosclerosis in a short amount of time.”

  • The paper relies on this without support.

    CT can determine whether aneurysm is present by measuring the size of the artery.

    “It can also determine whether aneurysm is present by measuring the size of the artery.”

  • The paper relies on this without support.

    The degree of calcification, fats, and fiber content can be estimated to some extent based on the CT number.

    “as the degree of calcification, fats, and fiber content can be estimated to some extent based on the CT number”

  • The paper relies on this without support.

    MDCT offers superior imaging speed and spatial resolution, and enables visualization of diseases in all the arteries and coronary arteries.

    “Multidetector CT (MDCT) offers superior imaging speed and spatial resolution, and by injecting a contrast medium through the peripheral veins, it enables the visualization of diseases in all the arteries and coronary arteries.”

  • The paper relies on this without support.

    MRI is especially useful for detecting lesions in the brain, which include ischemic changes and cerebral infarction.

    “MRI is especially useful for detecting lesions in the brain, which include ischemic changes and cerebral infarction.”

  • The paper relies on this without support.

    MRA provides an excellent means for visualizing stenosis and obstructive lesions in the intracranial arteries, carotid arteries, aorta, renal arteries and other blood vessels.

    “MRA provides an excellent means for visualizing stenosis and obstructive lesions in the intracranial arteries, carotid arteries, aorta, renal arteries and other blood vessels.”

  • The paper relies on this without support.

    The properties of the plaques can also be assessed using MRI plaque imaging.

    “The properties of the plaques can also be assessed using MRI plaque imaging.”

  • The paper relies on this without support.

    Limitations such as eccentric plaques and compensatory remodeling hinder the accurate determination of plaque volume.

    “However, limitations such as eccentric plaques and compensatory remodeling hinder the accurate determination of plaque volume.”

  • The paper relies on this without support.

    IVUS, OCT and the vascular endoscope provide an excellent assessment of the plaque volume as well as the properties of the plaques.

    “Meanwhile, intravascular ultrasound (IVUS), optical coherence tomography (OCT) and the vascular endoscope are some other methods that provide an excellent assessment of the plaque volume as well as the properties of the plaques.”

  • The paper relies on this without support.

    ABI is an indicator of narrowing of the central major arteries from the ankle joint or the presence of obstructive lesions and the degree of compensation by collateral circulation.

    “This ratio is an indicator of narrowing of the central major arteries from the ankle joint or the presence of obstructive lesions and the degree of compensation by collateral circulation.”

  • The paper relies on this without support.

    The precision of the oscillometric method is low when used in cases of critical limb ischemia.

    “the precision of the oscillometric method is low when used in cases of critical limb ischemia.”

  • The paper relies on this without support.

    Measuring both the ABI and TBI allows us to gauge the peripheral artery obstructive lesions distal than ankle joints.

    “Measuring both the ABI and TBI allows us to gauge the peripheral artery obstructive lesions distal than ankle joints.”

  • The paper relies on this without support.

    The reference TBI value is ≥ 0.7, and the presence of obstructive lesions in the arteries of the lower extremities should be suspected if the resulting value is ≤ 0.6.

    “The reference TBI value is ≥ 0.7, and the presence of obstructive lesions in the arteries of the lower extremities should be suspected if the resulting value is ≤ 0.6.”

  • The paper relies on this without support.

    PWV is an indicator of arterial stiffness and does not necessarily reflect atherosclerosis.

    “However, it is necessary to note that the PWV is an indicator of arterial stiffness and does not necessarily reflect atherosclerosis.”

  • The paper relies on this without support.

    PWV is proportionate to the stiffness and thickness of the arterial walls.

    “It is proportionate to the stiffness and thickness of the arterial walls.”

  • The paper relies on this without support.

    A baPWV of 1,400 cm/sec corresponds to the moderate risk level in the Framingham Risk Score.

    “A baPWV of 1,400 cm/sec corresponds to the moderate risk level in the Framingham Risk Score.”

  • The authors state this as an assumption.

    Unknown genetic factors play a role in the association between family history of CAD and CAD risk.

    “it is assumed that unknown genetic factors play a role170) as family history remains a strong risk factor even after adjusting all the traditional risk factors in multivariate analyses80, 166–168, 175, 176).”

  • The paper relies on this without support.

    The threshold of each risk grade cannot be determined statistically by using the absolute risk; the criteria were based on clinical consensus and social conventions.

    “As the threshold of each risk grade cannot be determined statistically by using the absolute risk, the criteria were based on clinical consensus and social conventions.”

  • The paper relies on this without support.

    Our society's guidelines must maintain continuity and consistency with the risk categorization used in our guidelines before.

    “Our society's guidelines must maintain continuity and consistency with the risk categorization used in our guidelines before.”

  • The authors state this as an assumption.

    A family history of premature CAD and impaired glucose tolerance carry the same level of risk as the other factors included in the assessment method.

    “In addition, a family history of premature CAD, which is absent in the Suita score, and impaired glucose tolerance are considered to carry the same level of risk as the other factors included in the assessment method and are therefore also counted as risk factors.”

  • The authors state this as an assumption.

    Risk scores have been basically created assuming that they apply to patients with risk factors, including dyslipidemia, that are not being treated.

    “In addition, the risk scores have been basically created assuming that they apply to patients with risk factors, including dyslipidemia, that are not being treated.”

  • The paper relies on this without support.

    The actual risks of cerebro- and cardiovascular diseases differ in patients with or without antihypertensive drug treatment.

    “The currently available risk scoring tools can be used even if the patient is on medication, but the actual risks of cerebro- and cardiovascular diseases differ in patients with or without antihypertensive drug treatment.”

  • The paper relies on this without support.

    The findings from the cited clinical trials and meta-analyses are generalizable to the Japanese population.

    “Although the absolute risk of CAD is lower in the Japanese population than in Western countries, the relative risk of LDL-C and CAD is similar.”

  • The paper relies on this without support.

    The evidence levels assigned to the cited studies accurately reflect the quality of evidence.

    “It has been proven that the effects of LDL-C-lowering therapy using statins to decrease the relative risk of ASCVD incidence are observed regardless of race and absolute risk. (Evidence level 1+, recommendation level A)”

  • The paper relies on this without support.

    The main adverse drug reaction of PCSK9 inhibitors is a reaction at the injection site, and other adverse reactions include nasopharyngitis and gastroenteritis.

    “As these medications are injected subcutaneously, the main adverse drug reaction reported is a reaction at the injection site, whereas others include nasopharyngitis and gastroenteritis.”

  • The paper relies on this without support.

    Lomitapide's major adverse drug reactions include accumulation of fat in the liver, abdominal pain, and diarrhea.

    “However, major adverse drug reactions include accumulation of fat in the liver, abdominal pain, and diarrhea.”

  • The paper relies on this without support.

    Fibrates are the most effective medications for hypertriglyceridemia.

    “Fibrates are the most effective medications for hypertriglyceridemia.”

  • The paper relies on this without support.

    Patients who have experienced acute coronary syndrome have a higher risk of recurrence for cardiovascular events than patients with stable coronary artery disease.

    “Patients who have experienced ACS have a higher risk of recurrence for cardiovascular events than patients with stable CAD.”

  • The paper relies on this without support.

    ASCVD conditions such as coronary artery disease, cerebrovascular diseases, and peripheral arterial disease are mutually high-risk conditions for vascular complications.

    “ASCVD that occurs with atherosclerosis as an underlying basis, such as CAD, cerebrovascular diseases, and PAD, are mutually high-risk conditions for vascular complications.”

  • The paper relies on this without support.

    The basis of metabolic syndrome is the excessive accumulation of visceral fat.

    “The basis of metabolic syndrome is the excessive accumulation of visceral fat.”

  • The paper relies on this without support.

    Multiple risk factors of ASCVD are present in metabolic syndrome.

    “Multiple risk factors of ASCVD are present in this condition.”

  • The paper relies on this without support.

    Visceral fat accumulation is an independent risk factor for CVD.

    “Visceral fat accumulation is considered an independent risk factor for CVD.”

  • The paper relies on this without support.

    An elevated serum uric acid level is associated with an increase in metabolic syndrome incidence.

    “An elevated serum uric acid level is believed to be associated with an increase in metabolic syndrome incidence.”

  • The paper relies on this without support.

    Exercise results in improvements in dyslipidemia (increase in HDL-C), decrease blood pressure, improve insulin resistance, and decrease blood glucose levels.

    “Exercise has been shown to result in improvements in dyslipidemia (increase in HDL-C level, etc.), decrease blood pressure, improve insulin resistance, and decrease blood glucose levels.”

  • The paper relies on this without support.

    The increased risk of CAD in nonsmokers because of passive smoking is a serious issue.

    “The increased risk of CAD in nonsmokers because of passive smoking is also a serious issue.”

  • The paper relies on this without support.

    Normal walking is equivalent to 3 METs, brisk walking is 4 METs, and jogging is 7 METs.

    “Normal walking is equivalent to 3 METs, while brisk walking is 4 METs and jogging is 7 METs; however, these values differ according to each individual's physical fitness.”
50 of 50

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Another Japanese guideline for CVD prevention recommended a low-salt Japanese dietary pattern (that is, lean meats, reduced butter and other animal fats, and consumption of soy, fish, vegetables, seaweed, mushrooms, fruit, and unpolished grains).

    “As noted previously, 1 diabetes guideline from Japan recommended limited intake of fruit owing to higher sugar content from selective breeding [46], and another Japanese guideline for CVD prevention recommended a low-salt Japanese dietary pattern (that is, lean meats, reduced butter and other animal fats, and consumption of soy, fish, vegetables, seaweed, mushrooms, fruit, and unpolished grains) [”

    From Commonalities among Dietary Recommendations from 2010 to 2021 Clinical Practice Guidelines: A Meta-Epidemiological Study from the American College of Lifestyle Medicine (2023) · cites this paper as [58]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • SHARP discussion points to CQ22 rather than the current CQ27

    Minor

    The SHARP discussion appears under CQ27, which asks about combination therapy, but calls it "CQ22." CQ22 instead concerns the LDL-C target for high-risk primary prevention.

  • Absolute-risk review is labeled CQ1 instead of CQ6

    Minor

    The review says it answers CQ1, but the paper labels the absolute-risk assessment question CQ6. CQ1 instead asks whether LDL-C predicts ASCVD incidence and mortality.

2 of 2

Cites

2 retracted

Flagged first, then by citations

3 of the 970 references couldn’t be matched to a known paper.

Research works printed but not linked: 45

  1. 11) Mizuta R, Kubota Y, Takeshita S, Akutsu H, Nakamoto F, Tanaka N, Sano M, Okajima T, Tsutsumi Y. Transit time of vessel flow in below-knee is useful for screening of vessel in below-knee lesions. Japanese journal of medical ultrasound technology, 2009; 34: 543-547 (in Japanese)
  2. 13) Subcommittee for preparing guidelines on ultrasound diagnosis of renal arteries. Guidelines on methods of standard assessment of ultradound diagnosis of renal arterial lesions. Jpn J Med Ultrasonics, 2015; 42: 185-200 (in Japanese) · DOI
  3. 71) Kitamura A, Noda H, Nakamura M, Kiyama M, Okada T, Imano H, Ohira T, Sato S, Yamagishi K, Iso H. Association between non-high-density lipoprotein cholesterol levels and the incidence of coronary heart disease among Japanese: The Circulatory Risk in Communities Study (CIRCS). J Atheroscler Thromb, 2011; 18: 454-463 · DOI · Paper page
  4. 73) Noda H, Iso H, Irie F, Sairenchi T, Ohtaka E, Ohta H. Association between non-high-density lipoprotein cholesterol concentrations and mortality from coronary heart disease among Japanese men and women: The Ibaraki Prefectural Health Study. J Atheroscler Thromb, 2010; 17: 30-36 · DOI · Paper page
  5. 93) Iso H, Imano H, Yamagishi K, Ohira T, Cui R, Noda H, Sato S, Kiyama M, Okada T, Hitsumoto S, Tanigawa T, Kitamura A. Fasting and non-fasting triglycerides and risk of ischemic cardiovascular disease in Japanese men and women: The Circulatory Risk in Communities Study (CIRCS). Atherosclerosis, 2014; 237: 361-368 · DOI · Paper page
  6. 120) Ministry of Health, Labour and Welfare of Japan. Review conference on the health impacts of smoking. Segment 5 health impacts of smoke-free tobacco and electronic cigarettes. http://www.mhlw.go.jp/file/05-Shingikai-10901000Kenkoukyoku-Soumuka/0000172687.pdf
  7. 154) Japanese Society of Nephrology. Health guidance for the examinees of kidney medical checkup and suggestions to the referral criteria to medical institutions. 2017; 59: 38-42 (in Japanese)
  8. 173) Mabuchi H, Kita T, Matsuzaki M, Matsuzawa Y, Nakaya N, Oikawa S, Saito Y, Sasaki J, Shimamoto K, Itakura H, the J-LIT Study Group. Large scale cohort study of the relationship between serum cholesterol concentration and coronary events with low-dose simvastatin therapy in Japanese patients with hypercholesterolemia and coronary heart disease: Secondary prevention cohort study of the Japan Lipid Intervention Trial (J-LIT). Circ J, 2002; 66: 1096-1100 · DOI · Paper page
  9. 180) Matsuzaki M, Kita T, Mabuchi H, Matsuzawa Y, Nakaya N, Oikawa S, Saito Y, Sasaki J, Shimamoto K, Itakura H; and the J-LIT Study Group. Large scale cohort study of the relationship between serum cholesterol concentration and coronary events with low-dose simvastatin therapy in Japanese patients with hypercholesterolemia: Primary prevention cohort study of the Japan Lipid Intervention Trial (J-LIT) . Circ J, 2002; 66: 1087-1095 · DOI · Paper page
  10. 317) Okubo K, Kiyohara Y. Frequency of the metabolic syndrome in the general inhabitant. Rinsho to Kenkyu, 2004; 81: 1736-1740 (in Japanese)
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Authors
Kinoshita, M., Yokote, K., Arai, H., Iida, M., Ishigaki, Y., Ishibashi, S., Umemoto, S., Egusa, G., Ohmura, H., Okamura, T., Kihara, S., Koba, S., Saito, I., Shoji, T., Daida, H., Tsukamoto, K., Deguchi, J., Dohi, S., Dobashi, K., Hamaguchi, H., Hara, M., Hiro, T., Biro, S., Fujioka, Y., Maruyama, C., Miyamoto, Y., Murakami, Y., Yokode, M., Yoshida, H., Rakugi, H., Wakatsuki, A., Yamashita, S., & Committee for Epidemiology and Clinical Management of Atherosclerosis
Affiliations
  • Toray Industries, Inc. (Japan) (JP)
  • Chiba University (JP)
  • National Center for Geriatrics and Gerontology (JP)
  • Gifu Prefectural General Medical Center (JP)
  • Iwate Medical University (JP)
  • Jichi Medical University (JP)
  • Hiroshima University Hospital (JP)
  • Egusa Genshi Clinic
  • Juntendo University (JP)
  • Keio University (JP)
  • The University of Osaka (JP)
  • SHOWA Medical University (JP)
  • Ehime University (JP)
  • Osaka City University (JP)
  • Teikyo University (JP)
  • Social Insurance Saitama Chuo Hospital (JP)
  • Mitsui Chemicals (Japan) (JP)
  • Kita Harima Medical Center (JP)
  • Teikyo University Hospital, Mizonokuchi (JP)
  • Nihon University (JP)
  • Tsukasa Health Care Hospital
  • Kobe Gakuin University (JP)
  • Japan Women's University (JP)
  • National Cerebral and Cardiovascular Center (JP)
  • Toho University (JP)
  • Kyoto University (JP)
  • Jikei University Kashiwa hospital (JP)
  • Aichi Medical University (JP)
  • Rinku General Medical Center (JP)
Corresponding author
Yamashita, Shizuya
ORCID
Venue
Journal of Atherosclerosis and Thrombosis
Publisher
Japan Atherosclerosis Society
Published
2018-09-01
Volume
25
Issue
9
Pages
846-984
ISSN
  • 1340-3478 (ISSN-L)
  • 1880-3873
DOI
10.5551/jat.gl2017
PMC
PMC6143773
OpenAlex
W65377277
Semantic Scholar
844a62b09886181f9545011df7ca37c1ed0814da
Cited by
813
References
970
Citations by year
2026: 26 · 2025: 66 · 2024: 89 · 2023: 95 · 2022: 147 · 2021: 128 · 2020: 124 · 2019: 63 · 2018: 17 · 2017: 8 · 2016: 6 · 2015: 3 · 2014: 15 · 2013: 8 · 2012: 5
FWCI
86.28
Type
journal article
Language
en
Open access
Licence
cc-by-nc-sa
Locations
  • Journal of Atherosclerosis and Thrombosis (publishedVersion, cc-by-nc-sa)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • Institutional Repositories DataBase (IRDB) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
atherosclerotic cardiovascular disease, cardiovascular disease prevention, risk assessment, metabolic syndrome, absolute risk estimation, lifestyle modification, pharmacotherapy, familial hypercholesterolemia, primary dyslipidemia, older adults, women, children
MeSH terms
Adult, Aged, Cardiovascular Diseases, Female, Humans, Japan, Life Style, Male, Middle Aged, Practice Patterns, Physicians', Risk Factors, Societies, Medical, Atherosclerosis

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