Combined effect of blood pressure and total cholesterol levels on long-term risks of subtypes of cardiovascular death: Evidence for cardiovascular prevention from observational cohorts in Japan

(EPOCH-JAPAN) Research Group

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Abstract

No large-scale, longitudinal studies have examined the combined effects of blood pressure (BP) and total cholesterol levels on long-term risks for subtypes of cardiovascular death in an Asian population. To investigate these relationships, a meta-analysis of individual participant data, which included 73 916 Japanese subjects (age, 57.7 years; men, 41.1%) from 11 cohorts, was conducted. During a mean follow-up of 15.0 years, deaths from coronary heart disease, ischemic stroke, and intraparenchymal hemorrhage occurred in 770, 724, and 345 cases, respectively. Cohort-stratified Cox proportional hazard models were used. After stratifying the participants by 4 systolic BP ×4 total cholesterol categories, the group with systolic BP ≥160 mm Hg with total cholesterol ≥5.7 mmol/L had the greatest risk for coronary heart disease death (adjusted hazard ratio, 4.39; P<0.0001 versus group with systolic BP <120 mm Hg and total cholesterol <4.7 mmol/L). The adjusted hazard ratios of systolic BP (per 20 mm Hg) increased with increases in total cholesterol categories (hazard ratio, 1.52; P<0.0001 in group with total cholesterol ≥5.7 mmol/L). Similarly, the adjusted hazard ratios of total cholesterol increased with increases in systolic BP categories (P for interaction ≤0.04). Systolic BP was positively associated with ischemic stroke and intraparenchymal hemorrhage death, and total cholesterol was inversely associated with intraparenchymal hemorrhage, but no significant interactions between BP and total cholesterol were observed for stroke. High BP and high total cholesterol can synergistically increase the risk for coronary heart disease death but not for stroke in the Asian population.

Original languageEnglish
Pages (from-to)517-524
Number of pages8
JournalHypertension
Volume65
Issue number3
DOIs
Publication statusPublished - 2015 Mar 4

Fingerprint

Japan
Cholesterol
Blood Pressure
Stroke
Coronary Disease
Hemorrhage
Proportional Hazards Models
Population
Longitudinal Studies
Meta-Analysis
Hypertension

Keywords

  • Asia
  • coronary disease
  • epidemiology
  • hypercholesterolemia
  • hypertension
  • meta-analysis
  • stroke

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

@article{72539e5ea8a04c188a5740139c3c1bf0,
title = "Combined effect of blood pressure and total cholesterol levels on long-term risks of subtypes of cardiovascular death: Evidence for cardiovascular prevention from observational cohorts in Japan",
abstract = "No large-scale, longitudinal studies have examined the combined effects of blood pressure (BP) and total cholesterol levels on long-term risks for subtypes of cardiovascular death in an Asian population. To investigate these relationships, a meta-analysis of individual participant data, which included 73 916 Japanese subjects (age, 57.7 years; men, 41.1{\%}) from 11 cohorts, was conducted. During a mean follow-up of 15.0 years, deaths from coronary heart disease, ischemic stroke, and intraparenchymal hemorrhage occurred in 770, 724, and 345 cases, respectively. Cohort-stratified Cox proportional hazard models were used. After stratifying the participants by 4 systolic BP ×4 total cholesterol categories, the group with systolic BP ≥160 mm Hg with total cholesterol ≥5.7 mmol/L had the greatest risk for coronary heart disease death (adjusted hazard ratio, 4.39; P<0.0001 versus group with systolic BP <120 mm Hg and total cholesterol <4.7 mmol/L). The adjusted hazard ratios of systolic BP (per 20 mm Hg) increased with increases in total cholesterol categories (hazard ratio, 1.52; P<0.0001 in group with total cholesterol ≥5.7 mmol/L). Similarly, the adjusted hazard ratios of total cholesterol increased with increases in systolic BP categories (P for interaction ≤0.04). Systolic BP was positively associated with ischemic stroke and intraparenchymal hemorrhage death, and total cholesterol was inversely associated with intraparenchymal hemorrhage, but no significant interactions between BP and total cholesterol were observed for stroke. High BP and high total cholesterol can synergistically increase the risk for coronary heart disease death but not for stroke in the Asian population.",
keywords = "Asia, coronary disease, epidemiology, hypercholesterolemia, hypertension, meta-analysis, stroke",
author = "{(EPOCH-JAPAN) Research Group} and Michihiro Satoh and Takayoshi Ohkubo and Kei Asayama and Yoshitaka Murakami and Masaru Sakurai and Hideaki Nakagawa and Hiroyasu Iso and Akira Okayama and Katsuyuki Miura and Yutaka Imai and Hirotsugu Ueshima and Tomonori Okamura",
year = "2015",
month = "3",
day = "4",
doi = "10.1161/HYPERTENSIONAHA.114.04639",
language = "English",
volume = "65",
pages = "517--524",
journal = "Hypertension",
issn = "0194-911X",
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TY - JOUR

T1 - Combined effect of blood pressure and total cholesterol levels on long-term risks of subtypes of cardiovascular death

T2 - Evidence for cardiovascular prevention from observational cohorts in Japan

AU - (EPOCH-JAPAN) Research Group

AU - Satoh, Michihiro

AU - Ohkubo, Takayoshi

AU - Asayama, Kei

AU - Murakami, Yoshitaka

AU - Sakurai, Masaru

AU - Nakagawa, Hideaki

AU - Iso, Hiroyasu

AU - Okayama, Akira

AU - Miura, Katsuyuki

AU - Imai, Yutaka

AU - Ueshima, Hirotsugu

AU - Okamura, Tomonori

PY - 2015/3/4

Y1 - 2015/3/4

N2 - No large-scale, longitudinal studies have examined the combined effects of blood pressure (BP) and total cholesterol levels on long-term risks for subtypes of cardiovascular death in an Asian population. To investigate these relationships, a meta-analysis of individual participant data, which included 73 916 Japanese subjects (age, 57.7 years; men, 41.1%) from 11 cohorts, was conducted. During a mean follow-up of 15.0 years, deaths from coronary heart disease, ischemic stroke, and intraparenchymal hemorrhage occurred in 770, 724, and 345 cases, respectively. Cohort-stratified Cox proportional hazard models were used. After stratifying the participants by 4 systolic BP ×4 total cholesterol categories, the group with systolic BP ≥160 mm Hg with total cholesterol ≥5.7 mmol/L had the greatest risk for coronary heart disease death (adjusted hazard ratio, 4.39; P<0.0001 versus group with systolic BP <120 mm Hg and total cholesterol <4.7 mmol/L). The adjusted hazard ratios of systolic BP (per 20 mm Hg) increased with increases in total cholesterol categories (hazard ratio, 1.52; P<0.0001 in group with total cholesterol ≥5.7 mmol/L). Similarly, the adjusted hazard ratios of total cholesterol increased with increases in systolic BP categories (P for interaction ≤0.04). Systolic BP was positively associated with ischemic stroke and intraparenchymal hemorrhage death, and total cholesterol was inversely associated with intraparenchymal hemorrhage, but no significant interactions between BP and total cholesterol were observed for stroke. High BP and high total cholesterol can synergistically increase the risk for coronary heart disease death but not for stroke in the Asian population.

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KW - Asia

KW - coronary disease

KW - epidemiology

KW - hypercholesterolemia

KW - hypertension

KW - meta-analysis

KW - stroke

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