Blood pressure, low-density lipoprotein cholesterol, and incidences of coronary artery disease and ischemic stroke in Japanese: The Suita study

Rumi Tsukinoki, Tomonori Okamura, Makoto Watanabe, Yoshihiro Kokubo, Kunihiro Nishimura, Misa Takegami, Yoshitaka Murakami, Akira Okayama, Yoshihiro Miyamoto

Research output: Contribution to journalArticle

13 Citations (Scopus)


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

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

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

CONCLUSIONS The HRs for CAD in prehypertensive and hypertensive groups were higher than those in the optimal BP group at the same LDL-C levels in a Japanese population; however, there was no statistical effect modification of LDL-C on the BP-CAD association.

Original languageEnglish
Pages (from-to)1362-1369
Number of pages8
JournalAmerican journal of hypertension
Issue number11
Publication statusPublished - 2014 Jul 27



  • Asian
  • Blood pressure
  • Cohort study
  • Coronary artery disease
  • Hypertension
  • Incidence
  • Ischemic stroke
  • Low-density lipoprotein cholesterol
  • Suita Study

ASJC Scopus subject areas

  • Internal Medicine

Cite this