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Metabolic syndrome (MetS) and its components are well established as risk factors for cardiovascular disease (CVD). On the other hand, it has also been reported that social isolation is associated with an increased risk of CVD. However, the relationship between social isolation and MetS and its components is not clear. Thus, the purpose of this study is to investigate the association between social isolation and the number of MetS components in Japanese adults. Participants were 28,917 individuals (male/female = 10,226/18,691, age = 59.9±11.6 years) from the Iwate area of the Tohoku Medical Megabank Organization Community-based cohort study (TMM CommCohort study). They had no history of coronary heart disease or stroke. Social isolation was assessed using the Lubben Social Network Scale-6 (LSNS-6). The participants were classified into two groups, the social isolation group and the non-isolation group, based on a cutoff point of 11/12 on the LSNS-6. An assessment of MetS used the criteria defined by the Japanese societies’ committee. The multivariate-adjusted odds ratios (95% confidence intervals) [AORs (95% CIs)] of the social isolation group versus the non-isolation group were calculated using ordered logistic analyses and compared to the number of MetS components. We used gender, age, education, current smoker, current alcohol drinker, total physical activity, current job status, and depression as covariates. AORs (95% CIs) of social isolation against non-isolation were 1.02 (0.95-1.09) for one component of MetS, 1.09 (1.01-1.19) for two components of MetS, and 1.16 (1.06-1.28) for three or more components of MetS, when compared to 0 component of MetS. In conclusion, Japanese adults who experience social isolation might have a greater number of MetS components.

Introduction: High dietary sodium-to-potassium (Na/K) ratio contributes to increased risk of cardiovascular disease (CVD) events. Previous studies on Japanese people suggested that women living in a multi-generational household (i.e., with spouse-children-parents; or spouse-parents) had a 2-3 fold higher risk of CVD events than women living with spouses only. However, few studies have examined the effect of living arrangement on urinary (U) Na/K. We clarified whether those living in a multi-generational household had higher UNa/K than those living with spouses only. Methods: We analyzed data of 44,085 residents (20-74 years), enrolled in the Tohoku Medical Megabank Project Community-based Cohort (TMM CommCohort) Study. UNa/K ratios were derived by dividing urinary Na levels (mEq/L) by urinary K levels (mEq/L) using spot urine samples. Participants were categorized into “living with spouse only”, “living with spouse and children”, “living with spouse and parents”, “living with parents and children”, “living with child only”, and “living with spouse, children and parents”. Using analysis of covariance, multivariate-adjusted geometric means of UNa/K ratios in each group were calculated by sex, with adjustments for other variables. Results: Those in a multi-generational household with spouse-children-parents had significantly higher multivariate-adjusted geometric means of UNa/K ratios in both sexes than those living with spouses. In male, those in a multi-generational household with spouse-childrenhad significantly higher multivariate-adjusted geometric means of UNa/K ratios than those living with spouses. In female those in a multi-generational household with spouse-parents or with children-parents had significantly higher multivariate-adjusted geometric means of UNa/K ratios than those living with spouses. Conclusions: This study suggests that those living in a multi-generational household have higher UNa/K ratios, which might contribute to an increased risk of CVD events.

Introduction: The risk factors that contribute to future disability after heart failure (HF) are poorly understood. The aim of this study was to determine the risk factors of future disability subsequent to HF in the general elderly population in Japan. Hypothesis: We assessed the hypothesis that unfavorable social factors after than traditional cardiovascular risk factors contribute to an increased risk for disability after HF. Methods: The subjects were community-dwelling elderly individuals aged 65 years or older without a history of cardiovascular diseases. We defined disabled subjects as individuals who had been newly certified by the long-term care insurance (LTCI) system during the observation period. HF was diagnosed according to the Framingham diagnostic criteria. After excluding subjects who received LTCI without HF (n= 2,305) and subjects who had already received LTCI prior to HF onset (n=33), we classified the remaining subjects (n= 4,644) into 3 groups: event-free (no LTCI and no HF; n= 4,548, mean age = 70.1 years at the baseline survey), no LTCI after HF (n= 52, mean age = 72.3 years) and LTCI after HF (n= 44, mean age =74.6 years). We determined the multivariate-adjusted odds ratio (OR) for having each risk factor (male gender, age (increment of years), unmarried status, less educational years ( Results: The median follow-up period was 10.6 years (49,133 person-years), and the median period [interquartile range] from the incidence of HF to the certification for LTCI was 1.3 [0.3- 4.7] years. Significantly associated risk factors were more advanced age (OR [95% confidence intervals]:1.18 [1.10-1.25]), unmarried status (2.29 [1.14- 4.63]), less educational years (3.36 [1.72-6.55]) and regular drinking (2.58 [1.13- 5.88]) in the group of LTC after HF, while the risk factor was more advanced age (1.08 [1.02-1.15]) in the group of no LTCI after HF. Conclusion: The results suggested that unfavorable social risk factors such as unmarried status, shorter education period and regular drinking strongly contributed to the higher risk of disability subsequent to HF, while those unfavorable risk factors did not contribute to the risk of incident HF without LTCI. Preventive measures must be taken to protect elderly individuals with unfavorable social factors from disability after HF via a multidisciplinary approach.

An increase in xanthine oxidoreductase (XOR) activity is related to various diseases such as diabetes, hypertension and obesity has been reported. However, so far the association with XOR activity and pathogenesis of atherosclerosis in a general Japanese population are not known. The purpose of this study is to investigate the association between XOR activity and progression of atherosclerosis including pulse wave velocity (PWV) and flow mediated dilation (FMD) in a general Japanese population. The Iwate Tohoku Medical Megabank Organization pooled individual participant data from a general population-based cohort study in Iwate prefecture (n = 810, male / female = 271 / 539, age = 67.6 ± 7.2). Plasma levels of XOR activity in males were marginally higher than in females (89.6 ± 187.0 vs. 64.8 ± 145.8 pmol / h/ mL, p = 0.06). Arterial stiffness by PWV after log10 transformation was significantly higher in quartiles III and IV of XOR compared to quartiles I in females (F =4.768, p < 0.01) (quartiles I vs. III, 3.187 ± 0.088 vs. 3.214 ± 0.081, p < 0.01; quartiles I vs. IV, 3.187 ± 0.088 vs. 3.213 ± 0.080, p < 0.05). Endothelial function as assessed by FMD was significantly lower in quartiles III and IV compared to quartiles I in females (F = 6.074, p < 0.001) (quartiles I vs. III, 6.02 ± 3.19 vs. 4.90 ± 2.66 %, p < 0.01; quartiles I vs. IV, 6.02 ± 3.19 vs. 5.04 ± 2.76 %, p < 0.01). XOR activity was related to progression of atherosclerosis (FMD, OR = 0.930, p = 0.06) and the high risk for CVD in females (Suita Score ≥ 41, OR = 1.92, 95% confidence interval (CI) = 1.04 - 3.54, p < 0.05). XOR activity was no significant association with progression of atherosclerosis and the high risk for CVD in males. The area under the curve (AUC) for XOR activity combined with Suita score was 0.66 (95% CI = 0.52 - 0.77, p < 0.05). In conclusion, XOR activity is associated with endothelial dysfunction and increased arterial stiffness suggesting that elevated XOR activity may relate to progression of atherosclerosis and indicate the CV risk.

Introduction: There is an association between dietary sodium/potassium intake and the pathogenesis of hypertension and cardiovascular disease. Some reports have indicated a correlation between psychological distress and high sodium intake. Victims who are affected by natural disasters tend to consume an unbalanced diet, with high sodium and low potassium levels, which may stem partly from high psychological distress due to natural disasters. Hypothesis: We tested the hypothesis that house collapse was associated with high urine Na/K (UNa/K) ratios in victims of the Great East Japan Earthquake. We also hypothesized that psychological distress could modify the relationship between house collapse and UNa/K ratio. Methods: We analyzed complete data collected from 24,580 coastal residents who did not take anti-hypertensive medications, were 20 to 74 years of age, and were enrolled in the Tohoku Medical Megabank Project Community-based Cohort (TMM CommCohort) Study. Participants were recruited between 2013 and 2015 at municipality-specific health checkup sites in the Iwate and Miyagi Prefectures. UNa/K ratios were assessed using spot urine samples. Participants were classified into four groups according to the extent of house collapse: total collapse (TC, n=4206); half collapse (HC, n=2825); partial collapse (PC, n=5964); and no damage (ND, n=11585). Using a covariance analysis, the multivariate-adjusted geometric means of the UNa/K ratios according to the group of house collapse were calculated, with adjustments for sex, age, systolic blood pressure, estimated glomerular filtration rate, HbA1c level, low-density lipoprotein cholesterol level, Kessler Psychological Distress Scale (K6) score, current alcohol consumption, current smoking habits, and daily exercise. In addition, after stratification according to K6 score (9/10), the multivariate-adjusted geometric means of the Una/K ratios were calculated according to house collapse group. Results: The multivariate-adjusted geometric means (95% confidence intervals) of UNa/K ratios of those whose houses underwent TC, HC, and PC were 3.33 (3.28-3.39), 3.37 (3.30-3.44), and 3.34 (3.30-3.40), respectively, all of which were significantly greater than the value of 3.23 (3.20-3.27) that was observed for the ND group. In analysis stratified by K6 score, the same tendencies were observed in both groups of K6 Conclusions: House collapse was significantly associated with high UNa/K ratios, and psychological distress did not modify this association.

Introduction: Previous studies have indicated that the female gender is one of the important risk factors for disability after stroke; however, most studies have been conducted in Western countries, and the higher risk of disability after stroke observed in women is thought to be different in Japan, where the proportion of hemorrhagic stroke (HS) is relatively higher than that in Western countries. Hypothesis: We assessed the hypothesis that the higher risk of disability after stroke attributable to the female gender was different between ischemic stroke (IS) and HS. Methods: We used 10-year community-based cohort data of 8,698 participants aged 65 years or older without cardiovascular disease or long-term care insurance (LTCI) at the time of the baseline survey. The stroke incidence was confirmed by reviewing the Iwate Stroke Registry. Functional disability was defined as being newly certified by the LTCI system. Participants were classified into three groups: G1, event-free (no stroke and no disability, n=7,950); G2, no disability after stroke (IS=177, HS=55); and G3, disability after stroke (IS=346, HS=170). Multivariate-adjusted odds ratios (ORs) of the female gender in G2 and G3 (reference: G1) were calculated using multinomial logistic regression with adjustments for age, hypertension, diabetes, dyslipidemia, overweight, current smoking, regular alcohol consumption, and regular exercise separately in those with IS and HS. Results: The ORs of the female gender were not high in G3 in IS, while the OR (95% confidence interval) was significantly high in G3 (1.55 (1.03-2.34)) in HS (see table). Conclusions: The proportion of females in the subjects with disabilities after HS was significantly higher than the proportion of males after multivariate adjustment. This suggested that the female gender was a significant risk factor for disability after HS, but not after IS in Japanese community-dwelling individuals.

Background: Smoking is an important risk factor for cardiovascular disease, however, to what extent smoking increases excessive deaths and strokes in a general population has not been sufficiently examined especially in women. Methods: A total of 10,382 female and male participants aged 65 years or older were divided into two groups according to smoking status (current smoker; never smoker). Past smokers were excluded. Main outcomes were all-cause death and incident stroke. Age-adjusted mortality and incidence rates were estimated in the groups using Poisson’s regression analysis. Age-adjusted rate ratios (RR) and excess events (EE per 1000 person-years) attributable to smoking were determined using the rate in never smokers as a reference. Results: There were 1410 deaths and 735 strokes during the 9.0-year observation period (90,099 person-years). Smoking contributed to a 2.3-fold higher risk of death in women and 1.8-fold higher risk in men. It contributed to 12 excess deaths per 1000 person-years in both men and women. The rate ratio and excessive events of stroke were likely to be higher in women than those in men (RR: 2.6 vs. 1.6; EE: 9.3 vs 5.0, see table). Conclusion: Smoking significantly increases risks of death and stroke not only in men but also in women. Absolute risk difference of stroke attributable to smoking is likely to be larger in women than in men.

Background: Immigration studies reported that dyslipidemia is more prevalent in people living in a western lifestyle. However, it is not clear what kind of lifestyle and dietary factors contribute to this difference. Aim: To investigate whether lifestyle including dietary factors could explain the difference in serum lipids between Japanese in Japan and Japanese-Americans in Hawaii living a western lifestyle. Methods: Analyses were conducted in the INTERLIPID study, where four standardized in-depth 24-h dietary recalls were performed. Non-fasting blood was drawn from the participants who included 1,087 Japanese and 176 Japanese-American. Participants’ characteristics were described as means and SD , t test was used for the comparison of means between Hawaii and Japan. Multiple linear regression models were used to examine relationships between dietary and lifestyle factors and the difference in serum lipids levels (low-density lipoprotein cholesterol [LDL-C] and log transformed triglycerides [log-TG]) between Hawaii and Japan, adjusting for age, sex and site as the basic model. Other confounders were then added separately to the basic model. Percentage reduction of regression coefficient for the difference between Hawaii and Japan was calculated. Results: In men, LDL-C levels were significantly higher in Japanese-Americans (138.3 mg/dl) compared to Japanese in Japan (120.3mg/dl, P Conclusion: BMI explained about half of the higher LDL-C and TG levels in Japanese-Americans in Hawaii compared to Japanese in Japan. BMI together with other macro-nutrients contributed to about 70% of the difference. Further investigation is required to explore the remaining difference.

Introduction: Sizable numbers of people have tried low carbohydrate diets (LCD) of varied types; data are sparse on effects on cardiometabolic risk factors with different types of LCD. Hypothesis: We assessed the hypothesis that relationships of LCD score to cardiometabolic risk factors and an inflammatory marker, high-sensitivity C-reactive protein (CRP), are different among usual, animal-based, and plant-based LCD. Methods: We assessed serum concentrations of high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), high sensitivity C-reactive protein (CRP), and nutrient intakes by standardized methods in men and women ages 40 to 59 years from four population samples of Japanese in Japan (553 men and 544 women, combined). For people consuming usual, animal-based, and plant-based LCDs, we calculated LCD scores, based on relative level of fat, protein, and carbohydrate, by modifying the methods of Halton, et al. Instead of calculating scores based on animal or vegetable fat, we used saturated fatty acids (SFA) or monounsaturated fatty acids (MUFA) +polyunsaturated fatty acids (PUFA). Multiple linear regression analyses were used to examine relations of LCD scores to log-CRP and cardiometabolic risk factors. Results: In multivariate regression analyses with adjustment for site, age, sex, BMI, smoking, alcohol intake, physical activity, years of education, and Keys dietary lipid score, all three LCD scores were significantly directly related to HDLc (all Ps Conclusions: All three LCD scores were significantly directly related to HDLc, but not to LDLc. The plant-based LCD score, associated with higher PUFA and lower SFA and dietary cholesterol in comparison with the other two LCD scores, was significantly inversely related to log-CRP.

Background: Obesity is an established risk factor for hypertension and end stage kidney disease. There is little information on how obesity relates to risk of impaired renal function in apparently healthy individuals. We investigated associations of body mass index (BMI) with timed 24-hour creatinine clearance (Ccr) and glomerular filtration rate (GFR) in the cross-sectional population-based INTERLIPID Study, ancillary study of the International Study on Macro- and Micro-Nutrients and Blood Pressure (INTERMAP). Methods: INTERLIPID participants ages 40-59 y from 5 INTERMAP research samples (4 Japanese and 1 Hawaiian) were investigated. Participants were ethnically all Japanese. Two timed 24-hour urine specimens were collected by each participant and analyses were performed in a central laboratory. Values of serum creatinine (Scr) were assayed by Jaffe’s method in a Japanese central laboratory. Data were analyzed from 1,338 Japanese, 570 men and 563 women in Japan, 100 men and 105 women in Hawaii. Measures of kidney function were 24-hour Ccr (ml/min) and GFR (ml/min/1.73m 2 ). Ccr was calculated by equation (urine creatinine х urine volume)/(Scr х 1440); GFR was calculated as Ccr х (1.73/body surface area (BSA)). BSA was estimated by the DuBois formula. In addition, estimated GFR (eGFR) was calculated by use of the Modification of Diet in Renal Disease (MDRD) Study equation, 186 х Scr -1.154 х age -0.203 х 0.742 (if female). All statistical analyses were stratified by gender. Adjusted mean values of Ccr, GFR, and eGFR in quartiles of BMI were estimated using analysis of covariance. Model 1 was adjusted for age; model 2, for age and urine volume; model 3 for variables in model 2 plus blood pressure, pulse rate, physical activity, smoking habit, alcohol consumption, urinary sodium excretion, HbA1c, and total serum cholesterol. Results: Ccr (mean (SD)) were 107.5 (18.9) in men in Japan, 91.9 (17.0) in women in Japan, 123.4 (25.1) in men in Hawaii, and 98.5 (20.3) in women in Hawaii. BMI quartile ranges were in men Q1 16.8-22.3, Q2 22.3-24.1, Q3 24.1-26.1, and Q4 26.1-42.9; in women Q1 15.9-21.2, Q2 21.2-23.0, Q3 23.0-25.1, and Q4 25.1-47.0. In men, BMI was positively related to multivariate-adjusted Ccr and GFR ( P for trend across BMI quartiles P for trend 0.001). In women, BMI was positively related to multivariate-adjusted Ccr ( P for trend across BMI quartiles Conclusions: These results indicate that excess BMI may lead to higher Ccr, and that the MDRD equation may underestimate GFR in middle-aged overweight or obese Japanese men.

Background: Studies have found that HDL particle (HDL-P) concentration is inversely associated with risk of CVD, independent of HDL cholesterol (HDL-C). Dietary factors (such as fatty acid intake) have been found to affect levels of HDL-C and influence risk of CVD. However, little is known about the associations of dietary fatty acid with serum HDL-P levels. Hypothesis: We hypothesized that dietary fatty acid associations with HDL-P are independent of HDL-C in men. Methods: Data were from 463 male participants in the 1996-98 cross-sectional INTERLIPID Study, ages 40-59 years, randomly selected from five populations; four in Japan (n=386) and one in Hawaii (n=77). Fatty acid intake was estimated from the mean of four in-depth 24-hour dietary recalls (% kcal per day). Individuals were excluded due to missing data on HDL-P or HDL-C and use of lipid lowering medication. Serum HDL-P was measured using nuclear magnetic resonance and HDL-C was measured using standard methods. Multiple linear regression models were used to assess the association between dietary fatty acid and each of the lipid measures. Results: In men, HDL-P and HDL-C were moderately correlated (r = 0.52, p Conclusion: HDL-P was significantly associated with fatty acid intake, independent of HDL-C. Associations of dietary fatty acid intake and HDL-C level were weaker and generally not independent of HDL-P in men.

Objective: To examine the association between body mass index (BMI) and incident stroke in Japanese elderly men. Methods: A total of 4743 men and aged 65 years and over (mean age, 72 years) who had no history of stroke or myocardial infarction were followed up prospectively for 5.4 years. Stroke events were identified by accessing the Iwate Stroke Registry. Participants were classified into 6 groups according to BMI (kg/m 2 ): less than 18.5, 18.5–20.9, 21.0–22.9, 23.0–24.9 (reference), 25.0–27.4, and 27.5 and over. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for ischemic stroke and hemorrhagic stroke according to BMI were estimated with adjustments for age, systolic blood pressure levels, total cholesterol levels, HDL cholesterol levels, HbA1c levels, current smoking, regular drinking and regular exercise using Cox’s regression. Results: During the follow-up, 171 ischemic and 58 hemorrhagic strokes occurred. Compared to men with BMI of 23.0–24.9, men with BMI of 25.0–27.4 and BMI of 27.5 and over had 1.6- and 1.9-fold higher risks for ischemic stroke, respectively, and men with BMI of less than 18.5 and 18.5–21.9 had 4.1- and 2.5-fold higher risks for hemorrhagic stroke, respectively. (See Table ) Conclusion: The findings suggest that low BMI (less than 21) is an independent risk factor for hemorrhagic stroke and that high BMI (25 and over) is an independent risk factor for ischemic stroke in Japanese elderly men. Table Multivariate HRs (95% CIs) for stroke according to BMI in Japanese eldery men BMI (kg/m 2 ) Less than 18.5 18.5–20.9 21.0–22.9 23.0–24.9 25.0–27.4 27.5 and over No. of subjects 138 725 1126 1283 1018 453 Ischemic stroke No. of cases 3 29 41 33 42 23 Incidence rate 4.32 7.49 6.75 4.81 7.72 9.66 HR (95% CI) 0.82 (0.25–2.72) 1.45 (0.86–2.43) 1.38 (0.87–2.19) 1 (reference) 1.58 (1.00–2.51) 1.92 (1.12–3.30) Hemorrhagic stroke No. of cases 4 15 12 10 11 6 Incidence rate 5.66 3.81 1.94 1.44 1.99 2.45 HR (95% CI) 4.10 (1.24–13.6) 2.53 (1.10–5.82) 1.32 (0.57–3.08) 1 (reference) 1.40 (0.59–3.31) 1.62 (0.58–4.52) Incidence rate was defined as number of cases per 1000 person-years.

Background: Inappropriate sleeping time contributes to an increased risk for death in general populations, however, whether inappropriate sleeping time contributes to an increased risk for death among hemodialysis patients has not been fully examined. Methods: A total of 1195 Japanese hemodialysis patients (769 men, 61.0 years of age; 426 women, 61.1 years of age) were enrolled. Participants were classified into 5 groups according to daily sleeping time: Group A (< 6 hours), Group B (6.0-6.9), Group C (7.0-7.9 (reference)), Group D (8.0-8.9), and Group E (9.0 hours and over). Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cause-specific deaths (all-cause, cardiac, cerebrovascular, sudden cardiac, infectious disease) in each category compared with reference were estimated with adjustments for age, male sex, systolic blood pressure, total cholesterol levels, HDL cholesterol levels, HbA1c levels, serum albumin levels, serum C-reactive protein levels, smoking status, drinking habit, and comorbid conditions (myocardial infarction, stroke and malignant disease) using Cox's regression analysis. Results: A total of 444 patients died during the 5-year observation (4732.6 person-years, mean follow-up period of 3.96 years). Group A and E had significantly higher risks for all-cause death, Group D had a 2.6-fold higher risk for cerebrovascular death and Group A had a 2.5-fold higher risk for sudden cardiac death compared to references. (See Table ) Number of deaths, crude mortality rates and hazard ratios for cause-specific death category Group A ( Group B (6-6.9 hrs) Group C (7-7.9 hrs) Group D (8-8.9 hrs) Group E (>=9 hrs) subjects (n) 155 213 262 271 294 all-cause death (mortality) 61 (101) 59 (65.8) 61 (54.9) 103 (96.2) 160 (152.5) all-cause death HR (95% CI) 1.49 (1.03-2.16) 1.31 (0.91-1.89) ref 1.34 (0.97-1.86) 1.64 (1.20-2.23) cardiac death (mortality) 16 (26.4) 15 (16.7) 17 (15.3) 29 (27.1) 41 (39.1) cardiac death HR (95% CI) 1.42 (0.71-2.87) 1.17 (0.58-2.34) ref 1.39 (0.76-2.55) 1.62 (0.90-2.91) cerebrovascular death (mortality) 9 (14.9) 5 (5.57) 6 (5.40) 18 (16.8) 17 (16.2) cerebrovascular death HR (95% CI) 2.69 (0.95-7.62) 1.18 (0.36-3.88) ref 2.61 (1.02-6.68) 2.24 (0.86-5.83) sudden cardiac death (mortality) 20 (33.1) 13 (14.5) 12 (10.8) 21 (19.6) 33 (31.5) sudden cardiac death HR (95% CI) 2.49 (1.15-5.38) 1.52 (0.67-3.47) ref 1.48 (0.71-3.09) 1.82 (0.90-3.70) infectious death (mortality) 11 (18.2) 15 (16.7) 24 (21.6) 26 (24.3) 41 (39.1) infectious death HR (95% CI) 0.68 (0.33-1.42) 0.88 (0.46-1.70) ref 0.82 (0.46-1.46) 0.91 (0.53-1.55) Crude mortality rates are expressed as /1000 person-years. Conclusion: Insufficient sleeping time was associated with a high risk for sudden cardiac death and excessive sleeping time was associated with a high risk for cerebrovascular death among hemodialysis patients. More attention should be paid to appropriate sleeping time in hemodialysis patients to prevent cardiovascular death.

Elevated plasma B-type natriuretic peptide (BNP) levels have been reported to be a marker for risk of cardiovascular events (CVE) including heart failure, coronary artery disease and stroke in the general population. However, plasma BNP is increased by renal dysfunction, and it is therefore not known whether plasma BNP might be a reliable biomarker for predicting onset of CVE in the cohort with impaired renal function as represented by chronic kidney disease (CKD). Baseline data including plasma BNP, serum creatinine, and urine protein were determined in 14265 participants from a community-based population. Estimated glomerular filtration rate (eGFR) was calculated using a modified MDRD equation, and CKD was defined by the following two methods (Def 1 = eGFR2 and/or proteinuria; Def 2 = eGFR2 ). Numbers of CKD subjects were 1927 according to Def 1 and 1604 according to Def 2. CVE endpoint was surveyed prospectively. The mean follow-up duration was 2.9 years. After adjustment for traditional cardiovascular risk factors and atrial fibrillation, relative risk (RR) for CVE was significantly higher in the highest BNP quartile compared to the lowest BNP quartile according to both definitions (Def 1, RR=3.51, p ). Furthermore, the RR for a composite endpoint of CVE and death was also significantly higher in the highest BNP quartile, again by both definitions (Def1, RR=2.71, p

OBJECTIVES: Assess the percentage of persons with consciousness of reduced salt diet (RSD) in general population samples and estimate actual differences in Na intake between RSD participants and others based on two timed 24hr urinary (24hr-U) Na excretions. METHODS: Data from 4680 men and women ages 40 –59yr randomly selected from 17 general populations in four countries, Japan (n=1145), PRC (n=839), UK (n=501) and US (n=2195), in the International Study of Macro- and Micro-nutrients and Blood Pressure (INTERMAP). Awareness of RSD was surveyed by questionnaire. Participants provided timed 24hr-U samples twice; Na and K were measured. Means of 24hr-U Na, K excretions and Na/K ratio were compared between RSD and non-RSD participants. Values were also estimated adjusted for body weight, age and sex (multiple regression analysis). RESULTS: RSD participants were few, 3.1% (Japan), 1.3% (PRC), 4.8% (UK) and 7.2% (US). Similarly among hypertensive (HTN) participants, 9.0% (Japan), 5.8% (PRC), 10.3% (UK) and 14.7% (US). Mean 24hr-U Na excretions (SE)(mmol) for RSD and non-RSD participants were 184.3(7.8) vs. 198.8(1.7)(p=0.129) (Japan); 191.2(19.3) vs. 228.0(3.5)(p=0.228) (PRC); 167.3(14.0) vs. 144.1(2.2)(p=0.114) (UK); and 150.9(4.7) vs. 163.5(1.3)(p=0.010) (US); adjusted Na excretions, 180.0(8.6) vs. 198.9(1.5)(p=0.031) (Japan); 172.4(27.4) vs. 228.2(3.1)(p=0.043) (PRC); 156.3(9.2) vs. 144.6(2.0)(p=0.217) (UK); 149.9(4.2) vs. 163.6(1.2)(p=0.002) (US). There were no significant differences in adjusted K excretions; Na/K ratios gave results similar to those for Na for all four countries. Adjusted Na excretions for HTN participants were significantly lower than for non-HTN participants in Japan (186.5(4.0) vs. 200.3(1.6)(p=0.002)); significant differences were not observed for other countries. CONCLUSIONS: Only a small percent of all and of HTN participants reported following consciously RSD. While 24hr-U Na excretions tended to be significantly lower for RSD participants, total salt intakes were still high. To prevent CVD, it is important to implement salt reduction guidelines more aggressively.