Trend of Westernization of Etiology and Clinical Characteristics of Heart Failure Patients in Japan

Abstract

on behalf of the CHART-2 Investigators Background: Hospitalization due to acute heart failure syndrome (AHFS) is an indicator of worsened prognosis for patients with cardiovascular disease (CVD). The Chronic Heart Failure Analysis and Registry in the Tohoku District 2 (CHART-2) Study was designed to elucidate characteristics and prognosis of patients at high risk for CVD progression due to AHFS. Methods and Results:The CHART-2 Study is a prospective observational multicenter cohort study. Patients with overt HF, structural cardiac disorder but without HF, or with coronary artery disease (CAD) have been consecutively enrolled from October 2006. As of March 2010, a total of 10,219 patients have been recruited, making the Study the largest multicenter prospective cohort of HF patients in Japan. The mean patient age was 68.2± 12.3 years and male patients accounted for 69.8%. Overt HF was observed in 46.3% of patients; and 53.7% did not have HF but were at high risk for AHFS. As HF stage progressed, the prognostic risks (eg, chronic kidney disease, reduced ejection fraction, and increased B-type natriuretic peptide level) became more prominent. Compared with the previous CHART-1 study, the prevalence of ischemic etiology and risk factors (hypertension, diabetes) have increased, as in Western studies. Conclusions:This first report demonstrates the trend of westernization of ischemic etiology and clinical characteristics of HF patients in Japan, indicating the importance of appropriate management and prevention of CAD to prevent AHFS. (Circ J 2011; 75: 823 - 833)

Predicting Coronary Heart Disease Using Risk Factor Categories for a Japanese Urban Population, and Comparison with the Framingham Risk Score: The Suita Study

“…The external validation of our score must be evaluated in other cohort studies, although a lack of external validation is a common problem with the existing Japanese risk prediction tools, including the NIPPON DATA 80, JALS, JMS cohort and Hisayama study. Considering the increasingly Westernized lifestyle in urban areas 52) , these tools should be re-evaluated using a consortium of cohort studies, which include both urban and rural areas, such as the Epoch-Japan study group 53) . Very recently, the new AHA/ACC Guideline on the Treatment of Blood Cholesterol recommended the use of the new Pooled Cohort Equations to estimate the 10-year CHD risk in both white and black males and females, aged 40-75 years, and the FRS is no longer used for risk assessment 54) .…”

Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure – Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers –

“…For calculation of PS, we used a logistic regression model in which the treatment status of loop diuretics was regressed for the following 31 baseline characteristics: age, male sex, systolic and diastolic blood pressure (SBP and DBP), heart rate, BMI, New York Heart Association (NYHA) class, history of hospitalization for HF, hypertension, attending physician(s) at each hospital and was confirmed by one independent physician who was a member of the Tohoku Heart Failure Association. 15 …”

Epidemiology of Heart Failure in Asia

“…54, 55 Our recent studies have also revealed an increasing trend towards ischemic etiology and comorbidities with DM and HT in Japanese HF patients. 10 The CHART-1 study, which enrolled . Recent trend towards ischemic etiology for heart failure in Asia.…”

“…Recent trend towards ischemic etiology for heart failure in Asia. In both Japan (CHART studies) 10 and China, 18 the prevalence of coronary artery disease (CAD), hypertension (HT) and diabetes (DM) increased as a cause or comorbidity of heart failure. HF Epidemiology in Asia β-blockers, ACEI/ARB, diuretics and aldosterone antagonists, 16 although there are few reliable data.…”