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• Epidemiology of Cardiovascular Diseases in Okinawa

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Published Papers 【 display / non-display 】

• Effectiveness of digital health interventions for telemedicine/telehealth for managing blood pressure in adults: a systematic review and meta-analysis

  Sakima, A; Akagi, Y; Akasaki, Y; Fujii, T; Haze, T; Kawakami-Mori, F; Kitajima, K; Kobayashi, Y; Matayoshi, T; Sakaguchi, T; Yamazato, M; Abe, M; Ohya, Y; Arima, H

  HYPERTENSION RESEARCH ( Hypertension Research )    2024.07 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  This systematic review and meta-analysis included randomized controlled trials or observational studies that compare digital health interventions (DHIs) for telemedicine/telehealth versus usual care for managing blood pressure (BP) in adults. We searched PubMed, Cochrane CENTRAL, and IchuShi-Web, and used a random-effects meta-analysis of the weighted mean difference (MD) between the comparison groups to pool data from the included studies. The outcome included the pooled MD of office BP from baseline to each follow-up period. This meta-analysis considered 117 studies with 68677 participants as eligible. The 3-month intervention period reduced office systolic BP (SBP) compared with usual care in 38 studies (MD: -3.21 mmHg [95% confidence interval: -4.51 to -1.90]), with evidence of heterogeneity. Office SBP across intervention periods demonstrated comparable effects (3-, 6- [54 studies], 12- [43 studies], and >12-month periods [9 studies]). The benefits for office diastolic BP were similar to those for office SBP. Additionally, the interventions significantly reduced the office SBP compared with the control, regardless of the mode of intervention delivery (smartphone apps [38 studies], text messages [35 studies], and websites [34 studies]) or type of facility (medical [74 studies] vs. non-medical [33 studies]). The interventions were more effective in 41 hypertension cohorts compared with 66 non-hypertension cohorts (-4.81 mmHg [-6.33, -3.29] vs. -2.17 mmHg [-3.15, -1.19], P = 0.006 for heterogeneity). In conclusion, DHIs for telemedicine/telehealth improved BP management compared with usual care. The effectiveness with heterogeneity should be considered, as prudent for implementing evidence-based medicine. This meta-analysis considered 117 studies with 68677 participants eligible. The DHIs for telemedicine/telehealth reduced office BP compared with usual care, regardless of intervention duration, intervention delivery mode, facility type, and cohort type. Additionally, the DHIs reduced the risk of uncontrolled BP compared with usual care, regardless of intervention duration, intervention delivery mode, and facility type. BP blood pressure, DHI digital health intervention, MD mean difference, RR risk ratio, SBP systolic blood pressure.

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• Impacts of Febuxostat on Cerebral and Cardiovascular Events in Elderly Patients with Hyperuricemia: Post Hoc Analysis of a Randomized Controlled Trial.

  Masahiro Sugawara, Sunao Kojima, Ichiro Hisatome, Kunihiko Matsui, Kazuaki Uchiyama, Naoto Yokota, Eiichi Tokutake, Yutaka Wakasa, Shinya Hiramitsu, Masako Waki, Hideaki Jinnouchi, Hirokazu Kakuda, Takahiro Hayashi, Naoki Kawai, Hisao Mori, Kenichi Tsujita, Yusuke Ohya, Kazuo Kimura, Yoshihiko Saito, Hisao Ogawa

  Clinical pharmacology and therapeutics   115 ( 6 ) 1358 - 1364   2024.06 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  A recent meta-analysis found no benefit of uric acid-lowering therapy including febuxostat on death, cardiovascular events, or renal impairment. However, there may be populations that benefit from febuxostat in reducing mortality and cerebral and cardiovascular events. The aim of the present study was to examine the clinical benefit of febuxostat in elderly patients stratified by age using Febuxostat for Cerebral and CaRdiorenovascular Events PrEvEntion StuDy (FREED) data. FREED was a randomized study involving patients aged 65 years or older with hyperuricemia and risk factors for cerebral, cardiovascular, or renal diseases. A total of 1,070 patients were included in this post hoc analysis, divided into 2 age groups: 65-74 years and ≥ 75 years. Patients were randomized into febuxostat and non-febuxostat groups, with uric acid levels monitored for 36 months. The primary composite end point included cerebral, cardiovascular, and renal events. In patients aged between 65 and 74 years, febuxostat significantly reduced the risk of future cerebral and cardiorenovascular events. However, no effects of febuxostat were found in the older population aged ≥ 75 years. Heterogeneity in potential interactions between the age and febuxostat treatment was particularly observed in non-fatal cerebral and cardiovascular events and all-cause death. Patients aged ≥ 75 years exhibited more pre-existing factors associated with cerebral and cardiorenovascular events than those aged 65-74 years. The effectiveness of febuxostat varies by age group, with potential benefits for patients aged 65-74 years. The effects of febuxostat are complex and it is important to consider patient characteristics in its clinical use.

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• Role of Small Dense Low-density Lipoprotein Cholesterol in Cardiovascular Events in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus Receiving Statin Treatment

  Yamaji, T; Harada, T; Kajikawa, M; Maruhashi, T; Kishimoto, S; Yusoff, FM; Chayama, K; Goto, C; Nakashima, A; Tomiyama, H; Takase, B; Kohro, T; Suzuki, T; Ishizu, T; Ueda, S; Yamazaki, T; Furumoto, T; Kario, K; Inoue, T; Watanabe, K; Takemoto, Y; Hano, T; Sata, M; Ishibashi, Y; Node, K; Maemura, K; Ohya, Y; Furukawa, T; Ito, H; Yamashina, A; Koba, S; Higashi, Y

  JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS ( 一般社団法人 日本動脈硬化学会 )  31 ( 4 ) 478 - 500   2024

  Type of publication: Research paper (scientific journal)

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  <p> <b>Aim:</b> There is little information on the relationships of serum small dense low-density lipoprotein cholesterol (sdLDL-C) levels and serum triglyceride (TG) levels with cardiovascular events in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (DM) who are receiving statins. The aim of this study was to evaluate the relationships of serum TG levels and sdLDL-C levels as residual risks for cardiovascular events in patients with CAD and type 2 DM who were being treated with statins.</p><p><b>Methods:</b> The subjects were divided into four groups based on TG levels and sdLDL-C levels: sdLDL-C of ＜40.0 mg/dL and TG of ＜150 mg/dL, sdLDL-C of ≥ 40.0 mg/dL and TG of ＜150 mg/dL, sdLDL-C of ＜40.0 mg/dL and TG of ≥ 150 mg/dL, and sdLDL-C of ≥ 40.0 mg/dL and TG of ≥ 150 mg/dL. During a median follow-up period of 1419 days, cardiovascular events occurred in 34 patients.</p><p><b>Results:</b> The incidences of cardiovascular events were significantly higher in patients with sdLDL-C of ≥ 40.0 mg/dL and TG of ＜150 mg/dL and in patients with sdLDL-C of ≥ 40.0 mg/dL and TG of ≥ 150 mg/dL, but not in patients with sdLDL-C of ＜40.0 mg/dL and TG of ≥ 150 mg/dL, than in patients with sdLDL-C of ＜40.0 mg/dL and TG of ＜150 mg/dL.</p><p><b>Conclusions:</b> Under the condition of treatment with statins, patients with CAD and type 2 DM who had sdLDL-C levels of ≥ 40.0 mg/dL had a high risk for cardiovascular events even though serum TG levels were controlled at ＜150 mg/dL.</p>

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• Enlarged Perivascular Spaces Are Independently Associated with High Pulse Wave Velocity: A Cross-Sectional Study.

  Kinjo Y, Saji N, Murotani K, Sakima H, Takeda A, Sakurai T, Ohya Y, Kusunose K

  Journal of Alzheimer's disease : JAD ( Journal of Alzheimer's Disease )  101 ( 2 ) 627 - 636   2024 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  BACKGROUND: Recent studies have demonstrated an association between pulse wave velocity (PWV), cerebral small vessel disease (SVD), and cognitive impairment such as Alzheimer's disease. However, the association between brachial-ankle PWV and enlarged perivascular spaces (EPVS), one component of cerebral SVD remains controversial. OBJECTIVE: To investigate the relationship between brachial-ankle PWV and EPVS severity in participants without dementia. METHODS: We performed a cross-sectional study of data of 74 participants from sub-analysis of ongoing research. We assessed cognitive function, brachial-ankle PWV, and brain magnetic resonance imaging (MRI) features. Using brain MRI, EPVS were separately assessed as basal ganglia (BG)-EPVS or centrum semiovale (CSO)-EPVS on the basis of their location. The relationship between EPVS severity and brachial-ankle PWV was evaluated using multivariable ordinal logistic regression analyses. RESULTS: We analyzed 74 participants (women: 47%, mean age: 73 years, mild cognitive impairment [MCI]: 74%). Compared with participants with normal cognition, those with MCI were more likely to have both severe BG-EPVS and severe CSO-EPVS. In multivariable analyses, high brachial-ankle PWV and age were independently associated with BG-EPVS severity (odds ratio [95% confidence interval]: 1.19 [1.02-1.38], 1.09 [1.01-1.17], respectively), whereas only age was independently associated with CSO-EPVS severity. A causal mediation analysis under a counterfactual approach revealed a significant pure natural indirect effect of brachial-ankle PWV on MCI that was mediated by BG-EPVS (estimate: 1.04, 95% CI: 1.01-1.12, p = 0.006). CONCLUSIONS: Brachial-ankle PWV was associated with BG-EPVS severity. High PWV may cause cerebrovascular pulsatility, which accelerates BG-EPVS and may worsen cognitive impairment.

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• Achievement rate of target blood pressure in patients with hypertension treated by hypertension specialists and non-specialists in a real-world setting

  Sakima, A; Yamazato, M; Kohagura, K; Ishida, A; Matayoshi, T; Tana, T; Nakamura, Y; Ohya, Y

  HYPERTENSION RESEARCH ( Hypertension Research )  46 ( 11 ) 2460 - 2469   2023.11 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  Hypertension remains a major global healthcare issue. Considering that most Japanese patients with hypertension are managed by general practitioners, hypertension specialists should be involved in actual clinical practice. We investigated the blood pressure (BP), guidelines recommended for achievement rate of the target BP, and clinical variables of patients with hypertension treated by hypertension specialists and those treated by non-specialists in a real-world setting. Factors associated with the target BP achievement in this population were also investigated. Outpatients with hypertension from 12 medical facilities in Okinawa Prefecture were enrolled (n = 1469 [specialist group, 794; non-specialist group, 675]; mean age, 64.2 years; females, 45.8%). For all patients, BP and rate of the target BP achievement were 129.0 ± 15.5/74.6 ± 10.6 mmHg, and 51.8%, respectively. BP and the rate of target of BP achievement were 128.0 ± 15.1/73.4 ± 10.4 mmHg and 56.7% in the specialist group, and they were 130.1 ± 15.9/76.0 ± 10.8 mmHg and 46.1% in the non-specialist group. The urinary salt excretion and obesity rates were comparable between the specialist and non-specialist groups. Multivariable logistic analyses indicated that hypertension specialists and good medication adherence were positive factors, whereas obesity, chronic kidney disease, diabetes mellitus, and urinary salt excretion were inverse factors associated with target BP achievement in this population. Initiatives for salt reduction, medication adherence, and proper obesity management are crucial to improving BP management in patients with hypertension. Hypertension specialists are expected to play an essential role in them. For all patients, the target blood pressure (BP) achievement rate were 51.8%. Hypertension specialists and good medication adherence were positive factors in achieving target BP; conversely, obesity, diabetes mellitus, chronic kidney disease, and high urinary salt excretion were inverse factors in achieving target BP among patients with hypertension.

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• パルボウィルス感染に伴うSLE様病態と鑑別を要したループス腎炎の一例

  平良浩菜, 大城菜々子, 大嶺久美子, 砂川祥頌, 中村卓人, 金城孝典, 山里正演, 石田明夫, 古波蔵健太郎, 大屋祐輔

  日本腎臓学会誌 ( (一社)日本腎臓学会 )  61 ( 6 ) 897 - 897   2019.08  [Refereed]

   

  J-GLOBAL

• 0〜20の気圧上昇中の長軸方向ステント長の短縮と伸長(Shortening and Elongation of Longitudinal Stent Length during Expansion of 0 to 20 Atmospheric Pressure)

  潮平 朝洋, 池宮城 秀一, 山里 正演, 岩淵 成志, 大屋 祐輔

  日本循環器学会学術集会抄録集 ( (一社)日本循環器学会 )  83回   PJ089 - 6   2019.03

   

• 心血管イベントのバイオマーカーとしてのアキレス腱肥厚の有用性に関する横断的研究

  新城 翔大, 池宮城 秀一, 石田 明夫, 大屋 祐輔

  琉球医学会誌 ( 琉球医学会 )  37 ( 1-4 ) 132 - 132   2018.12

   

• 外来通院中の高齢高血圧者における推定塩分摂取量と血圧のコントロール状況

  山里正演, 崎間敦, 田名毅, 中村義人, 石田明夫, 古波蔵健太郎, 大屋祐輔

  日本老年医学会雑誌 ( (一社)日本老年医学会 )  55 ( 4 ) 725‐726(J‐STAGE) - 726   2018.10

   

  J-GLOBAL

• 脳室内マクロファージの枯渇はアンジオテンシンII持続投与食塩負荷ラットの血圧上昇を抑制する

  山里正演, 石田明夫, 山里代利子, 中村卓人, 大屋祐輔

  日本高血圧学会総会プログラム・抄録集 ( (NPO)日本高血圧学会 )  41st (CD-ROM)   ROMBUNNO.OB06‐06 - 06   2018.09

   

  J-GLOBAL

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Grant-in-Aid for Scientific Research 【 display / non-display 】

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• Cardiovascular Risk Reduction in Atrial Fibrillation Trial

  Grant-in-Aid for Scientific Research(B)

  Project Year: 2019.04  -  2023.03 

  Direct: 13,200,000 (YEN)  Overheads: 17,160,000 (YEN)  Total: 3,960,000 (YEN)

• Grant-in-Aid for Scientific Research(C)

  Project Year: 2015.04  -  2018.03 

  Direct: 3,700,000 (YEN)  Overheads: 1,110,000 (YEN)  Total: 4,810,000 (YEN)

• WEB-based BP data delivey system improved qualty of life and BP contorol in elderly who lives in remote islands in Okinawa.

  Grant-in-Aid for Scientific Research(C)

  Project Year: 2015.04  -  2018.03 

  Investigator(s): Yusuke Ohya 

  Direct: 3,700,000 (YEN)  Overheads: 4,810,000 (YEN)  Total: 1,110,000 (YEN)

  　View Summary

  Most elderly are not familiar with information and communication technology(ICT), applications of ICT-based monitoring to elderly are limited. We used the home BP measurement device with automated transfer function via the internet to elderly who lived in seven remote islands in Okinawa (n=230, mean age; male 72 yeas old, female 80 years old). Support by health professionals enhanced their continuation of blood pressure (BP) measurement, while living alone was related with discontinuation. Use of the device did not change mean values of BP, but BP levels who had not known the importance of BP measurement before this projects decreased significantly. Use of the device improved the secure feeling of subjects and their families who lived afar. These results suggest that ICT-based BP self monitoring improved BP control and improved secure feeling of subjects and their families, but contribution of health professionals is also important.

• Contact Irreversible Electroporation of Cells and Tissues under the Control of the Electric Field and Temperature

  Grant-in-Aid for Scientific Research(A)

  Project Year: 2014.04  -  2018.03 

  Investigator(s): Takamatsu Hiroshi, SUMIMOTO Hideki, OYA Yusuke 

  Direct: 33,000,000 (YEN)  Overheads: 42,900,000 (YEN)  Total: 9,900,000 (YEN)

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  This study aimed to develop contact irreversible electroporation for treatment of superficial tumors by using electric pulses at extremely reduced voltages. We first developed a method to measure the temperature rise associated with considerably short electric pulses. We also showed that transient temperature rise during electroporation could be estimated by numerical analysis. Protein denaturation due to the excess electric pulses was detectable by using Raman spectroscopic measurement. We then fabricated comb-shaped miniature contact electrodes with the size and geometry optimized by numerical analysis. The electroporation with the electrode successfully necrotized the cells at the surface of a tissue phantom. Furthermore, the depth of the necrotized tissue was controllable by selecting the pulse parameters. We also confirmed that the use of adjuvants could reduce the magnitude of the electric field required for the treatment by up to 30%.

• Assessment of Whole Blood Rheology and Leukocyte Activity in ex vivo Microchannel Array Model to Contribute Cardiovascular Rehabilitation Research

  Grant-in-Aid for Scientific Research(C)

  Project Year: 2014.04  -  2017.03 

  Investigator(s): YASU TAKANORI 

  Direct: 3,700,000 (YEN)  Overheads: 4,810,000 (YEN)  Total: 1,110,000 (YEN)

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  Leucocytes play an important role in the all process of the atherosclerosis. However, clinically feasible parameters of leukocyte activation in microcirculation is limited. We developed a clinically feasible assessment method of leukocyte activity and blood rheology using a microchannel flow analyzer (MCFAN) with new designed silicon chips mimic to human microvascular network. The passage time of whole blood with heparin or EDTA-2Na+heparin through the microchannel arrays was measured using MC-FAN. Number of adhesive leukocytes (/field) was counted in offline as a gold standard of leukocyte activation. Subtraction of the passage time of blood with heparin and one with EDTA-2Na + heparin was significantly correlated with adhesive leukocyte number. The delta whole blood passage time may be a novel parameter reflecting leukocyte activity.

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