The present study suggested that CACS was an independent predictor of death in patients on chronic hemodialysis. Patients with a high CACS should be carefully monitored and evaluated for reversible prognostic factors such as dyslipidemia and, probably, hyperphosphatemia and a high value for the calcium x phosphate product.Electron-beam computed tomography (EBCT) is a noninvasive measure of coronary artery calcification and, therefore, could be a marker of developing cardiovascular disease. Whether the coronary artery calcification score (CACS) is a prognostic marker in chronic dialysis patients is not known.

The relation between serum uric acid level and cardiovascular risk factors is complex and has been investigated mainly in men. We examined the correlation between serum uric acid level and obesity, hypertension, dyslipidemia, and diabetes mellitus (DM) in both men and women of a screened cohort in Okinawa, Japan. A total of 9,914 individuals (6,163 men and 3,751 women ranging in age from 18 to 89 years) who were screened at Okinawa General Health Maintenance Association were subjects in this study. Hyperuricemia tality in individuals with ischemic heart disease (7), the specific role of serum uric acid in relation to cardiovascular disease remains unclear.The association between serum uric acid and other cardiovascular risk factors complicates the issue. Increased serum uric acid levels are often accompanied by obesity, dyslipidemia, and hypertension (8-11), all of which are associated with increased risk for cardiovascular disease. In Japan, there are reports suggesting a significant correlation between increased serum uric acid level and cardiovascular risk factors in large members of men, but not women (12). Okada et al. (13) showed a significant correlation between serum uric acid and cardiovascular risk factors, but the number of indi-

Several epidemiological studies have shown a positive association between serum uric acid levels and the risk of hypertension. However, subjects in these studies were mostly men, or were incompletely examined for lifestyle-related variables. We prospectively examined the relation between hyperuricemia and the risk of sociations between the serum uric acid levels and the risk of development of hypertension (5-10). Selby et al. (5) indicated that serum uric acid was closely linked to the development of hypertension and that it might be a marker of susceptibility or an intermediate step in the pathway leading to hypertension. In the Olivetti heart study (6), serum uric acid levels were positively associated with increased risk of hypertension, but analyses were adjusted only for age, body mass index (BMI), serum total cholesterol, and serum triglyceride. Control for confounders such as lifestyle factors was incomplete.In Japan, Nakanishi et al. (7) reported that the risk for development of hypertension over a 6-year period increased progressively as serum uric acid levels increased, even after

lustering of cardiovascular risk factors is significantly associated with hypertension 1 and increased risk of cardiovascular events. [2][3][4] Several epidemiological studies have reported that a high heart rate (HHR) is a predictor of cardiovascular and non-cardiovascular mortality, [5][6][7][8][9][10][11] and HHR has been associated with several cardiovascular risk factors, especially hypertension. 12 However, it is not certain whether the clustering of risk factors increases the risk for a higher HR or whether an accumulation of these risk factors is associated with HR even with a low HR (LHR). Our aim was to evaluate the association of HR with laboratory and clinical parameters and lifestyle factors such as smoking, drinking, and exercise habits in a screened cohort in Okinawa, Japan. Furthermore, we examined whether the clustering of cardiovascular risk factors increased the risk for HHR. Methods SubjectsIn 1997, the Okinawa General Health Maintenance Association (OGHMA) in Okinawa, Japan, held a one-day 'dry doc' clinic, in which 9,914 individuals participated, all of whom were over 18 years of age. The population of Okinawa at that time was 1,273,440 of whom 931,376 were over the age of 18 (Census, 1995). Thus the clinic particiJapanese Circulation Journal Vol. 65, November 2001 pants were about 1% of the general population aged 18 years or over. We excluded as subjects anyone who had been prescribed drugs for hypertension or heart disease, anyone who had not had an ECG recording, and anyone who had a record of ectopic beats or atrial fibrillation. Thus, a total of 8,508 subjects (5,299 men, 3,209 women; age range, 18-89 years) were examined. OGHMA operates the largest examination center in Okinawa, Japan 13 and the 'dry doc' program provides both a thorough physical examination for individuals and the health maintenance programs of companies and public organizations. About 10,000 people participate in this program each year. Individual histories of hypertension, diabetes mellitus, hyperlipidemia, smoking habits, drinking habits, and exercise habits are determined by self-administered questionnaires and physician interviews. Blood sampling is performed after overnight fasting. Trained nurses measure blood pressure twice using a standard sphygmomanometer after having the subject sit for 15 min. In the present study, the lower blood pressure value was used. An ECG was recorded after 2 min in the supine position. Height, body weight, fasting blood glucose, hemoglobin A1c (HbA1c), total cholesterol, triglyceride, and high-density lipoprotein cholesterol were measured for all subjects. Body mass index (BMI) was calculated as body weight (kg) divided by the square of the height (m 2 ). HR was calculated from the average of consecutive RR intervals in 5 s from the ECG recording.Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or antihypertensive drug use. Obesity was defined as BMI ≥25 kg/m 2 . Diabetes mellitus was defined as fasting blood glucose concentrati...

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