Background This large-scale observational study on negative events in a real-world setting investigated Japanese patients with atrial fibrillation who were not on anticoagulants. This study aims to evaluate the incidence of ischemic stroke and bleeding events (intracranial hemorrhage, gastrointestinal bleeding, others) based on CHA2DS2-VASc scores in Japanese patients with atrial fibrillation who were not anticoagulated. Methods and Results We used health checkups and insurance claim data from a Japanese insurance organization. Altogether, 9733 atrial fibrillation patients were not prescribed anticoagulation during their follow-up periods. Patients' risk levels were defined by their CHA2DS2-VASc scores (range 0-≥3): Men with scores of 0, 1, or ≥2 and women with scores of 1, 2, or ≥3 were considered at low, intermediate, or high risk, respectively. Cox proportional hazards model was used to assess the association between the CHA2DS2-VASc-determined risk and the incidence of ischemic stroke and intracranial, gastrointestinal, and other bleeding. The mean 2.5-year follow-up revealed 143 ischemic strokes and 332 bleeding events. Annual event rates were 0.58% for ischemic stroke and 1.17% for total bleeding events. Annual incidence of ischemic stroke increased with elevated predicted risks based on CHA2DS2-VASc scores: 0.18% for low-risk, 0.44% intermediate-risk, and 1.29% high-risk groups (P<0.001 for trend). Annual incidences of total bleeding also increased with elevated predicted risks: 0.51% for low-risk, 1.28% intermediate-risk, and 2.02% high-risk groups (P<0.001 for trend). Conclusions Risks of ischemic stroke and bleeding events were high, particularly among those with high CHA2DS2-VASc scores.
<b><i>Introduction:</i></b> Evidence using real-world data is sparse regarding the effects of oral anticoagulants (OACs) among patients with kidney disease. The aim of this study was to investigate the effects of kidney disease on ischemic stroke (IS) or systemic embolism (SE) among patients taking OAC, using large-scale real-world data in Japan. <b><i>Methods:</i></b> This was a retrospective cohort study using claims data and health checkup data from health insurance associations in Japan, from January 2005 to June 2017. We enrolled 21,581 patients diagnosed with atrial fibrillation (AF). Of the total population, 11,848 (54.9%) patients were taking OAC. A Cox proportional hazards model was used to examine the effect of kidney disease on IS/SE with or without OAC. <b><i>Results:</i></b> During follow-up, 208 participants who were not taking OAC (mean follow-up 2.6 years) and 200 who were taking OAC (mean follow-up 3.0 years) experienced IS/SE. The % IS/SE incidence rates with and without kidney disease were 2.42/person-year and 0.63/person-year in the total population, 3.66/person-year and 0.76/person-year in the group without OAC use, and 1.52/person-year and 0.55/person-year in patients with OAC use, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) of kidney disease for IS/SE were high, irrespective of OAC, even after adjustment: adjusted HR 2.62 (95% CI: 1.72–3.99) without OAC and adjusted HR 2.03 (95% CI: 1.20–3.44) with OAC; <i>p</i> = 0.193 for interaction between no OAC and OAC. Although bleeding risk was also high for kidney disease irrespective of OAC use (HR 2.93 [95% CI: 2.27–3.77] in the total population, HR 3.08 [95% CI: 2.15–4.43] in the group without OAC, and HR 2.73 [95% CI: 1.90–3.91] in the group with OAC use), net clinical benefit indicated that the benefit of OAC use exceeded the risk of bleeding: HR 4.50 (95% CI: 0.76–8.23) among those with kidney disease and HR 0.35 (95% CI: 0.04–0.66) among those without kidney disease. <b><i>Conclusion:</i></b> Although we found that OAC use was effective and recommended for patients with AF, advanced kidney disease is still an independent risk factor for IS/SE, even in patients taking OAC. Physicians should be aware of this risk and strictly control modifiable risk factors, regardless of OAC use.
It has been suggested that non-fasting triglyceride (TG) concentrations may be useful in predicting various diseases. However, current epidemiological evidence focuses mainly on the effects of fasting TG concentrations. The aim of this study was to investigate the effect of fasting and non-fasting TG levels on new-onset hyperuricemia (HUA) in the general Japanese population. This is a population-based retrospective cohort study (ISSA-CKD study); it included 5,576 participants without HUA at baseline between 2008 and 2019. Participants were categorized into gender-specific tertile groups of serum TG levels: group 1 (< 83 mg/dL [0.94 mmol/l] in male and < 77 mg/dL [0.87mmol/l] in female), group 2 (83-129mg/dL [0.94–1.46mmol/l] in male and 77-114 mg/dL [0.87–1.29mmol/l in female), and group 3 (≥ 130mg/dL [1.47 mmol/l] in male and ≥ 115 mg/dL [1.30mmol/l] in female). Outcome of this study was new-onset HUA (serum uric acid > 7 mg/dL [0.42 mmol/l]). During the 5.4-year follow-up period, 552 male and 146 female participants developed new-onset HUA. Incidence rates (per 1,000 person-years) of HUA were 18.2 in group 1, 21.9 in group 2 and 31.0 in group 3 among male, and 2.1 in group 1, 4.0 in group 2 and 7.4 group 3 among female. These associations remained significant after adjustment for confounders (p trend < 0.0001 among male and 0.0004 for female). There was no clear difference in effect of non-fasting and fasting TG levels on the development of new HUA (P interaction = 0.546 for male and 0.886 for female). Non-fasting and fasting TG concentrations were significantly associated with new-onset HUA among general Japanese men and women.
Abstract Background and objective Obesity hypoventilation syndrome ( OHS ) prevalence was previously estimated at 9% in patients with obstructive sleep apnoea ( OSA ) in J apan. However, the definition of OSA in that study was based on an apnoea‐hypopnoea index ( AHI ) of ≥ 20/h rather than ≥ 5/h. Therefore, the prevalence of OHS in OSA was not measured in the same way as for Western countries. Our study objectives were to investigate the characteristics of Japanese patients with OHS . Methods Nine hundred eighty‐one consecutive patients investigated for suspected OSA were enrolled. At least 90% of them were from urban areas, including 162 with obese OSA (body mass index ( BMI ) ≥ 30 kg/m 2 and AHI ≥ 5/h). Results The prevalence of OHS ( BMI 36.7 ± 4.9 kg/m 2 ) in OSA and that in obese OSA were 2.3% and 12.3%, respectively. Multiple regression analysis revealed that independent of age and BMI, arterial oxygen pressure (contribution rate (R 2 ) = 7.7%), 4% oxygen desaturation index (R 2 = 8.9%), carbon monoxide diffusing capacity/alveolar volume (R 2 = 8.3%), haemoglobin concentration (R 2 = 4.9%) and waist circumference (R 2 = 4.9%) were independently associated with arterial carbon dioxide pressure. After 12.3 ± 4.6 months of CPAP treatment, more than 60% of OHS patients no longer had hypercapnia. Conclusions The prevalence of OHS in OSA in J apan was 2.3%. The mean BMI of patients with OHS in J apan was lower than that in Western countries (36.7 kg/m 2 vs 44.0 kg/m 2 ).
Background : Both periodic limb movements during sleep (PLMS) and obstructive sleep apnea (OSA) are major causes of sleep disorders and are reported to be associated with cardiovascular diseases (CVD). However, whether the combination of PLMS and OSA promotes a greater risk of CVD than each condition alone is uncertain. Objectives : To investigate whether patients with both PLMS and OSA have a more elevated hypercoagulability than those with OSA only by examining plasma fibrinogen levels. Methods : Plasma fibrinogen levels were measured in 254 patients who had moderate to severe OSA revealed by diagnostic polysomnography. Results : In 46 (18%) of 254 patients, PLMS were found. Fibrinogen levels were significantly higher in patients with both PLMS and OSA than in those with OSA only (298.2±76.1 vs. 270.0±52.6 mg/dL, p Conclusion : PLMS were positively associated with plasma fibrinogen levels in OSA patients. Since the plasma fibrinogen level is an established predictive factor of future CVD events, PLMS can be a useful clinical sign to identify OSA patients with high risk of CVD.
Background: Obstructive sleep apnea (OSA) is associated with metabolic syndrome (MS) and its components, and its association with steatohepatitis has been reported. Fatty liver disease also has a strong relationship to visceral obesity (VO) and MS. However, whether OSA is independently related to liver fat accumulation is not known. Objectives: To investigate gender-specific relationships among OSA, liver fat content, VO and other MS-related variables. Methods: This study included 250 subjects (189 males, 61 females) who underwent diagnostic polysomnography and abdominal CT. The average CT value of liver (CT L ) was used as an alternative to liver fat content. Visceral fat area (VFA) and subcutaneous fat area (SFA) were also measured. Results: Among study subjects, average age, BMI and VFA were 57 years, 26.6 kg/m 2 , and 145 cm 2 , respectively. In males, VFA, 4% oxygen desaturation index, % sleep time of SpO 2 L were age, BMI, VFA, TG, HDL-cholesterol and fasting plasma glucose levels in males and BMI and TG in females. Multiple analysis also showed that, in addition to BMI, TG and HOMA-IR, %T90 was correlated with CT L (R 2 = 15.1%, P 2 ). Conclusions: Nocturnal hypoxia was an important risk factor for liver fat accumulation in male OSA patients without VO. Treatment of OSA might prevent or improve fatty liver disease in these patients.
