Abstract
Hypertension and smoking are major risk factors for death due to cardiovascular disease (CVD). These attributions for CVD mortality should be higher in the countries where obesity-related conditions are uncommon. However, the joint effect of these risk factors on CVD and all-cause mortality have not been described. We followed a representative 8,912 Japanese men and women without a history of stroke and heart disease. Participants were categorized into 4 groups as follows: a group of individuals who neither smoked nor had hypertension (HT), a group of current smokers, a group with HT, and a group of current smokers with HT. We further calculated population-attributable fractions (PAF) of CVD and all-cause mortality based on relative hazards assessed by proportional hazard regression models. After 19 years of follow-up, we observed 313 and 291 CVD and 948 and 766 all-cause deaths for men and women, respectively. The PAF of CVD mortality due to smoking or HT were 35.1% for men and 22.1% for women. The PAF of CVD mortality was higher in participants <60 years of age (57.4% for men and 40.7% for women) vs. those who were older (26.3% for men and 18.1% for women). Aggressive attempts to discourage smoking and to curb HT could yield large health benefits in Japan and throughout Asia, particularly for those aged <60 years. Efforts to warn about the adverse consequence of HT and smoking during adolescence and youth could yield the greatest health benefits, since positive behaviors adopted early are more easily continued into middle adulthood and later life.
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Chobanian AV, Bakris GL, Black HR, et al, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee : The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.
U.S. Department of Health and Human Services : The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, U.S. Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
The Fifth National Survey of Cardiovascular Diseases. Tokyo, Chuo-Hoki Publisher, 2003 ( in Japanese).
Ueshima H, Choudhury SR, Okayama A, et al: Cigarette smoking as a risk factor for stroke death in Japan: NIPPON DATA80. Stroke 2004; 35: 1836–1841.
Ko M, Kim MT, Nam JJ : Assessing risk factors of coronary heart disease and its risk prediction among Korean adults: the 2001 Korea National Health and Nutrition Examination Survey. Int J Cardiol 2006; 110: 184–190.
Wang L, Kong L, Wu F, Bai Y, Burton R : Preventing chronic diseases in China. Lancet 2005; 366: 1821–1824.
Ueshima H, Zhang XH, Choudhury SR : Epidemiology of hypertension in China and Japan. J Hum Hypertens 2000; 14: 765–769.
Martiniuk AL, Lee CM, Lam TH, et al, Asia Pacific Cohort Studies Collaboration : The fraction of ischaemic heart disease and stroke attributable to smoking in the WHO Western Pacific and South-East Asian regions. Tob Control 2006; 15: 181–188.
Martiniuk AL, Lee CM, Lawes CM, et al, for the Asia-Pacific Cohort Studies Collaboration : Hypertension: its prevalence and population-attributable fraction for mortality from cardiovascular disease in the Asia-Pacific region. J Hypertens 2007; 25: 73–79.
Iso H, Date C, Yamamoto A, et al, JACC Study Group: Smoking cessation and mortality from cardiovascular disease among Japanese men and women: the JACC Study. Am J Epidemiol 2005; 161: 170–179.
Sairenchi T, Iso H, Irie F, et al: Age-specific relationship between blood pressure and the risk of total and cardiovascular mortality in Japanese men and women. Hypertens Res 2005; 28: 901–919.
WHO Technical Report Series 894, WHO : Preventing and Managing the Global Epidemic. Part I. The Problem of Overweight and Obesity. Geneva, World Health Organization, 2000, pp 6–37.
Okamura T, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H, Nippon Data80 Research Group: What cause of mortality can we predict by cholesterol screening in the Japanese general population? J Intern Med 2003; 253: 169–180.
Iida M, Ueda K, Okayama A, et al, Nippon Data 80 Research Group: Impact of elevated blood pressure on mortality from all causes, cardiovascular diseases, heart disease and stroke among Japanese: 14 year follow-up of randomly selected population from Japanese—Nippon data 80. J Hum Hypertens 2003; 17: 851–857.
Okayama A, Kadowaki T, Okamura T, Hayakawa T, Ueshima H, The NIPPON DATA80 Research Group: Age-specific effects of systolic and diastolic blood pressures on mortality due to cardiovascular diseases among Japanese men (NIPPON DATA80). J Hypertens 2006; 24: 459–462.
Nakamura M, Sato S, Shimamoto T : Improvement in Japanese clinical laboratory measurements of total cholesterol and HDL-cholesterol by the US Cholesterol Reference Method Laboratory Network. J Athroscler Thromb 2003; 10: 145–153.
Rockhill B, Newman B, Weinberg C : Use and misuse of population attributable fractions. Am J Public Health 1998; 88: 15–19.
Hozawa A, Ohkubo T, Yamaguchi J, et al: Cigarette smoking and mortality in Japan: the Miyagi Cohort Study. J Epidemiol 2004; 14: S12–S17.
Hara M, Sobue T, Sasaki S, Tsugane S : Smoking and risk of premature death among middle-aged Japanese: ten-year follow-up of the Japan Public Health Center–based prospective study on cancer and cardiovascular diseases (JPHC Study) cohort I. Jpn J Cancer Res 2002; 93: 6–14.
Uno F, Ishikawa S, Nakamura Y, et al: Smoking and risk of all-cause mortality: the Jichi Medical School (JMS) Cohort Study. J Epidemiol 2005; 15: 173–179.
Arima H, Tanizaki Y, Kiyohara Y, et al: Validity of the JNC VI recommendations for the management of hypertension in a general population of Japanese elderly: the Hisayama study. Arch Intern Med 2003; 163: 361–366.
Rothman KJ : Epidemiology—An Introduction—. New York, Oxford University Press, 2002.
The National Health and Nutrition Survey in Japan. Tokyo, Daiichi Syuppan Publisher, 2003, Japan (in Japanese).
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Hozawa, A., Okamura, T., Murakami, Y. et al. Joint Impact of Smoking and Hypertension on Cardiovascular Disease and All-Cause Mortality in Japan: NIPPON DATA80, a 19-Year Follow-Up. Hypertens Res 30, 1169–1175 (2007). https://doi.org/10.1291/hypres.30.1169
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DOI: https://doi.org/10.1291/hypres.30.1169
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