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American Journal of Epidemiology Advance Access originally published online on January 22, 2007
American Journal of Epidemiology 2007 165(6):617-624; doi:10.1093/aje/kwk053
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American Journal of Epidemiology Copyright © 2007 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

ORIGINAL CONTRIBUTIONS

Less Subclinical Atherosclerosis in Japanese Men in Japan than in White Men in the United States in the Post–World War II Birth Cohort

Akira Sekikawa1,2, Hirotsugu Ueshima2, Takashi Kadowaki1,2, Aiman El-Saed1, Tomonori Okamura2, Tomoko Takamiya1, Atsunori Kashiwagi3, Daniel Edmundowicz4, Kiyoshi Murata5, Kim Sutton-Tyrrell1, Hiroshi Maegawa3, Rhobert W. Evans1, Yoshikuni Kita2, Lewis H. Kuller1 and for the ERA JUMP Study Group

1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
2 Department of Health Science, Shiga University of Medical Science, Otsu, Japan
3 Department of Internal Medicine: Endocrinology and Metabolism, Shiga University of Medical Science, Otsu, Japan
4 Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA
5 Department of Radiology, Shiga University of Medical Science, Otsu, Japan

Correspondence to Dr. Akira Sekikawa, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 North Bellefield Avenue, Suite 546, Pittsburgh, PA 15213 (e-mail: akira{at}pitt.edu).

Received for publication April 18, 2006. Accepted for publication August 21, 2006.

Coronary heart disease incidence and mortality remain very low in Japan despite major dietary changes and increases in risk factors that should have resulted in a substantial increase in coronary heart disease rates (Japanese paradox). Primary genetic effects are unlikely, given the substantial increase in coronary heart disease in Japanese migrating to the United States. For men aged 40–49 years, levels of total cholesterol and blood pressure have been similar in Japan and the United States throughout their lifetimes. The authors tested the hypothesis that levels of subclinical atherosclerosis, coronary artery calcification, and intima-media thickness of the carotid artery in men aged 40–49 years are similar in Japan and the United States. They conducted a population-based study of 493 randomly selected men: 250 in Kusatsu City, Shiga, Japan, and 243 White men in Allegheny County, Pennsylvania, in 2002–2005. Compared with the Whites, the Japanese had a less favorable profile regarding many risk factors. The prevalence ratio for the presence of a coronary calcium score of ≥10 for the Japanese compared with the Whites was 0.52 (95% confidence interval: 0.35, 0.76). Mean intima-media thickness was significantly lower in the Japanese (0.616 mm (standard error, 0.005) vs. 0.672 (standard error, 0.005) mm, p < 0.01). Both associations remained significant after adjusting for risk factors. The findings warrant further investigations.

atherosclerosis; cohort studies; coronary disease; Japan; men; risk factors

Abbreviations: CCS, coronary calcium score; CHD, coronary heart disease; CI, confidence interval; IMT, intima-media thickness


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