The Risk of Cardiovascular Events in Japanese Hypertensive Patients with Hypercholesterolemia: Sub-Analysis of the Japan Lipid Intervention Trial (J-LIT) Study, a Large-Scale Observational Cohort Study

Abstract

Coronary events and stroke are leading causes of death in Japan. However, the effects of hypertension on the risk of coronary events and stroke have not been well established in Japanese hypercholesterolemic patients. This study aimed to determine the relationship between the risk of coronary events or stroke and blood pressure and cholesterol levels during low-dose simvastatin treatment using data from the Japan Lipid Intervention Trial (J-LIT) study (a large scale nationwide cohort study). In the present study, 47,294 hypercholesterolemic patients were treated with open-labeled simvastatin (5 to 10 mg/day) for 6 years by a large number of physicians in a clinical setting. The adjusted incidence rates of coronary events in males and females were 8.9 and 2.3 and those of stroke were 17.6 and 11.3/1,000 patients during the 6-year period, respectively. The incidence rate of stroke was higher than that of coronary events in both males and females. An obvious sex difference was observed in terms of the incidence of coronary events. The risk of coronary events, stroke, and total cardiovascular events were increased, with elevations in blood pressure observed in patients treated for hypercholesterolemia. The risk of total cardiovascular events in the groups exhibiting less lipid control increased, with lower blood pressure levels than those of the well-controlled group. For patients with hypercholesterolemia and hypertension, blood pressure should be strictly controlled in order to prevent both coronary events and stroke, and the serum total cholesterol levels should be maintained at low levels as well. (Hypertens Res 2005; 28: 879-887)

Proposal of a Risk-Stratification System for the Japanese Population Based on Blood Pressure Levels: The Ohasama Study

“…In addition, normal BP and high-normal BP individuals with high cardiovascular risks (third class) had significantly different risk levels for stroke or TIA when the assessment was based on HBP. Several previous studies conducted in the Japanese population also support the current results, even based on CBP (18,19). It seems reasonable to suppose that we should assess both hypertensives and non-hypertensives in the next version of the Japanese BP guidelines, and that the importance of HBP should be more heavily emphasized in the revised guidelines for accurate evaluation of BP risks in individuals.…”

Impaired glucose tolerance is a risk factor for stroke in a Japanese sample—the Funagata study

“…Here, we evaluated separately the risks of IGT for stroke and CHD using a cohort study of a Japanese population. The incidence of stroke is higher (1.5-2.5 times more) than that of CHD in Japan [23][24][25]; therefore, the risk for stroke was evaluated more precisely in the present study. However, even in a previous study of Japanese subjects, IGT was shown to be a risk factor for CVD but not for stroke [26].…”

Does B-Type Natriuretic Peptide Predict the New Onset of Hypertension?

“…However, this study failed to prove a relationship between elevated baseline BNP levels and the risk of developing hypertension, indicating that additional investigation is necessary to confirm the association. Hypertension is a major risk factor for the development of cardiovascular disease (14)(15)(16)(17) and the ability to predict the onset of new hypertension is an attractive proposition (18). We hypothesized that normotensive individuals with higher plasma BNP levels have a higher probability of developing hypertension in the future.…”