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Background: End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke. Methods: Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition–Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million person-years of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25 917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank. Results: There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eGFR values 105 mL·min –1 ·1.73 m –2 , compared with those with eGFR between 60 and 105 mL·min –1 ·1.73 m –2 . Mendelian randomization analyses for CHD showed an association among participants with eGFR –1 ·1.73 m –2 , with a 14% (95% CI, 3%–27%) higher CHD risk per 5 mL·min –1 ·1.73 m –2 lower genetically predicted eGFR, but not for those with eGFR >105 mL·min –1 ·1.73 m –2 . Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin A1c, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD. Conclusions: In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function.

Background It is uncertain whether risk classification under the nationwide program on screening and lifestyle modification for metabolic syndrome captures well high‐risk individuals who could benefit from lifestyle interventions. We examined the validity of risk classification by linking the incidence of cardiovascular disease (CVD). Methods and Results Individual‐level data of 29 288 Japanese individuals aged 40 to 74 years without a history of CVD from 10 prospective cohort studies were used. Metabolic syndrome was defined as the presence of high abdominal obesity and/or overweight plus risk factors such as high blood pressure, high triglyceride or low high‐density lipoprotein cholesterol levels, and high blood glucose levels. The risk categories for lifestyle intervention were information supply only, motivation‐support intervention, and intensive support intervention. Sex‐ and age‐specific hazard ratios and population attributable fractions of CVD, which were also further adjusted to consider non–high density lipoprotein cholesterol levels, were estimated with reference to nonobese/overweight individuals, using Cox proportional hazard regression. Since the reference category included those with risk factors, we set a supernormal group (nonobese/overweight with no risk factor) as another reference. We documented 1023 incident CVD cases (565 men and 458 women). The adjusted CVD risk was 60% to 70% higher in men and women aged 40 to 64 years receiving an intensive support intervention, and 30% higher in women aged 65 to 74 years receiving a motivation‐support intervention, compared with nonobese/overweight individuals. The population attributable fractions in men and women aged 40 to 64 years receiving an intensive support intervention were 17.7% and 6.6%, respectively, while that in women aged 65 to 74 years receiving a motivation‐support intervention was 9.4%. Compared with the supernormal group, nonobese/overweight individuals with risk factors had similar hazard ratios and population attributable fractions as individuals with metabolic syndrome. Conclusions Similar CVD excess and attributable risks among individuals with metabolic syndrome components in the absence and presence of obesity/overweight imply the need for lifestyle modification in both high‐risk groups.

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.

Objective: In short-term feeding trials, replacement of other macronutrients with monounsaturated fatty acid reduces blood pressure. However, observational studies have not clearly demonstrated a relationship between monounsaturated fatty acid intake and blood pressure. We report associations of monounsaturated fatty acid intake of individuals with blood pressure in a cross-sectional study. Methods: The International Study of Macro/Micronutrients and Blood Pressure is a cross-sectional epidemiologic study of 4,680 men and women ages 40-59 from 17 population samples in China, Japan, United Kingdom, and United States. Nutrient intake data were based on four in-depth multi-pass 24-hour dietary recalls/person and two timed 24-hour urine collections/person. Blood pressure was measured eight times at four visits. Results: Mean monounsaturated fatty acid intake ranged from 8.1 %kcal (China) to 12.2%kcal (United States). With sequential models to control for possible confounders (dietary, other), linear regression analyses showed significant inverse relationship of total monounsaturated fatty acid intake with diastolic blood pressure for all participants; for 2,238 “non-intervened” individuals, the relationship was stronger. Estimated diastolic blood pressure differences with 2-SD higher monounsaturated fatty acids (5.35 %kcal) were -0.82 mm Hg (P

This study investigated the effect of hypertension on hospitalization risk and medical expenditure according to treatment status in a Japanese population.A total of 314 622 beneficiaries of the medical insurance system in Japan, aged 40-69 years, without a history of cardiovascular, cerebrovascular, or end-stage renal disease were classified into seven blood pressure categories. These categories were used to compare the risk of undergoing hospitalization in the 1 year after the baseline survey and to examine the percentage of inpatient medical expenditure attributable to overall hypertension relative to total medical expenditure in the study population.During the follow-up period, 6.6% of men and 5.1% of women were hospitalized. In men and women aged 40-54 years, cases of hypertension, especially grade 3 untreated hypertension, led to more frequent hospitalization, compared with optimal blood pressure. Individuals who were hospitalized, especially long-term, incurred considerably higher medical expenditure compared with those who were not hospitalized, regardless of their hypertension status. In women aged 55-69 years, there was little variation in hospitalization risk across blood pressure categories. The inpatient medical expenditure attributable to overall hypertension represented 7.2 and 6.9% of the total medical expenditure for men aged 40-54 and 55-69 years, whereas it represented 2.8 and 3.8% for women, respectively.Although cases of hypertension were an economic burden especially in men, grade 3 untreated hypertension was more likely to incur extremely high medical expenditure as a result of hospitalization, compared with other cases.

OBJECTIVE: A direct relationship of dietary cholesterol to blood pressure of men has been reported in a few observational studies from the USA. It is not clear whether this association prevails consistently, for example, in populations with varied dietary habits, across ethnic groups, and sexes. Cross-sectional data from the International Study of Macro/Micro-nutrients and Blood Pressure (INTERMAP) were used to assess relations of dietary cholesterol intake to blood pressure in men and women from four countries. METHODS: Data include 83 nutrients from four multipass 24-h dietary recalls and two-timed 24-h urine collections; eight blood pressure readings, and questionnaire data, for 4680 participants ages 40-59 years from 17 population samples in Japan, People's Republic of China, UK, and USA. RESULTS: With sequential models to control for multiple possible confounders (dietary, other), linear regression analyses showed that dietary cholesterol was directly related to SBP for all participants and for nonhypertensive individuals, but not to DBP. With adjustment for 12 variables, estimated SBP differences with 2SD for higher cholesterol intake (131.0 mg/1000 kcal) were 0.9 mmHg (P < 0.05) for all participants and 1.1 mmHg (P < 0.01) for nonhypertensive individuals, findings attenuated with addition of height and weight to the model. CONCLUSION: INTERMAP found a low-order, positive relationship of dietary cholesterol intake to SBP with control for multiple possible confounders. Reduction of dietary cholesterol intake may contribute to prevention and control of adverse blood pressure levels in general populations. J Hypertens

OBJECTIVES Human primary microRNA-155/B-cell integration cluster (BIC) transcript is the precursor of microRNA-155. The overexpression of them has been widely observed in the progression of various types of tumors. Our objective was to investigate the effect of anticancer agents on the expression of BIC and possible signal pathways that involved in. METHODS Quantitative real-time reverse transcriptase polymerase chain reaction was used to measure the expression of BIC. Chemical inhibitors against c-Jun N-terminal kinase 1, mitogen-activated protein kinase/extracellular signal-regulated kinase kinase 1/2, protein kinase C, checkpoint kinase 1, and phosphatidylinositol 3 kinase (PI3K) were used for the evaluation of involved signal pathways. RNA interference was used to knock down the expression of ataxia-telangiectasia mutated, ataxia-telangiectasia and Rad3 related, and suppressor of morphogenesis in genitalia-1 (SMG-1), and Western blot was carried out to evaluate the knockdown effect. RESULTS B-cell integration cluster expression was induced by a representative anti-pancreatic cancer drug, gemcitabine, in human pancreatic cancer PANC-1 cells. The mitogen-activated protein kinase/extracellular signal-regulated kinase kinase 1/2 and c-Jun N-terminal kinase inhibitors, but not the checkpoint kinase 1 and protein kinase C inhibitors, suppressed the up-regulation of BIC. B-cell integration cluster up-regulation was also significantly inhibited by the PI3K inhibitor wortmannin. RNA interference studies showed that wortmannin-sensitive SMG-1 but not ataxia-telangiectasia mutated or ataxia-telangiectasia and Rad3 related was involved in the up-regulation. CONCLUSIONS Our results show that multiple pathways can be involved in the up-regulation of BIC. Furthermore, we demonstrate for the first time that PI3K SMG-1 is required for gemcitabine-induced up-regulation of BIC transcript.

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.

Objective— We investigated whether dietary factors explain higher plasma fibrinogen levels in Japanese emigrants living a Western lifestyle in Hawaii compared with Japanese in Japan. Methods and Results— Plasma fibrinogen and nutrient intakes were examined by standardized methods in men and women 40 to 59 years of age from a Japanese-American sample in Hawaii (100 men and 106 women) and 4 population samples in Japan (569 men and 567 women). Multiple linear regression models were used to examine the relationship between dietary factors and the plasma fibrinogen difference between Hawaii and Japan. Average plasma fibrinogen was significantly higher in Hawaii compared with Japan ( P Conclusions— Higher intake of iron, sugar, and caffeine, in addition to obesity, account largely for higher fibrinogen levels with Westernized lifestyle.

Purpose of review Recent dietary guidelines for the prevention and treatment of hypertension emphasized a healthy eating pattern called the Dietary Approaches to Stop Hypertension (DASH) diet, in addition to avoidance of obesity, high salt intake, and excessive alcohol intake. Our new challenge is to examine the long-term efficacy and effectiveness of dietary change, including the DASH diet, on blood pressure in the general population, or in a high-risk population. We reviewed recent short-term and long-term studies, both observational and interventional, which investigated whether dietary change can reduce blood pressure. Recent findings The efficacy of several nutrients has been investigated in short-term trials (e.g. polyunsaturated fatty acids, including omega-3 fatty acids, and trans fatty acids), but no substantial effect of these nutrients on blood pressure has been proved, except for dietary fiber. The PREMIER trial showed the effectiveness of implementing the DASH diet for 6 months in addition to the established recommendations on lifestyle modification, but other long-term trials of dietary modification did not show sufficient blood pressure reduction. However, long-term observational studies have shown that a higher intake of fruit and vegetables and a lower intake of red meat (except fish) can prevent higher blood pressure increase with age. Summary More effective programs of dietary modification are needed to achieve greater reduction of blood pressure. Long-term studies of population-wide dietary interventions to decrease the blood pressure level of a whole population are also needed.

Information has been sparse on the comparison of 4 blood pressure (BP) indexes (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean BP [MBP]) in relation to long-term stroke incidence, especially in middle-aged and older Asian people. A prospective cohort study was performed in 4989 Japanese (1523 men and 3466 women) aged 35 to 79 at baseline with 10 years of follow-up. End points included stroke incidence (total, ischemic, and hemorrhagic). Multivariate-adjusted hazard ratios with a 1-SD higher value for each BP index were determined by Cox proportional hazard analyses; Wald χ 2 tests were used to compare the strength of relationships. Analyses were also done for each of 4 age-gender groups consisting of men and women aged 35 to 64 and 65 to 79 years. During follow-up, 132 participants developed stroke. Adjusted hazard ratios for all strokes were 1.68 for SBP, 1.72 for DBP, and 1.80 for MBP, which were higher than that for PP (1.34). SBP and DBP were related positively to stroke risk after adjustment of each other. PP was not the strongest predictor in any age-gender groups among 4 BP indexes. In men aged 65 to 79 years, SBP showed the strongest relationship to all stoke risk (hazard ratio 1.62) among 4 BP indexes. In women aged 65 to 79 years, hazard ratios for all strokes were 2.48 for MBP, 2.46 for DBP, 2.25 for SBP, and 1.57 for PP. The long-term incident stroke risk of high BP in Asians should be assessed by SBP and DBP together, or by MBP, not by PP.

OBJECTIVE To examine the association between hypertension and the C825T polymorphism in the G-protein beta 3 subunit gene in Japanese workers. METHODS This study used logistic regression analysis and multiple regression analyses to investigate whether the C825T polymorphism was associated independently with hypertension or blood pressure when factors such as age, body mass index, blood chemistry and lifestyle were taken into consideration. The target subjects were 1452 male and 1169 female workers selected from 3834 male and 2591 female workers in a single company. Hypertension was defined as a systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg, or taking antihypertensive medication. The power of the study was estimated as 83% for males and 41% for females based on allelic frequencies in Caucasians. RESULTS Genotype distributions for C825T in hypertensive males (CC = 58, CT = 135, TT = 63) and females (CC = 20, CT = 36, TT = 20) were not significantly different from normotensive males (CC = 300, CT = 614, TT = 282) or females (CC = 274, CT = 602, TT = 217), respectively. Allele distributions were not significantly different in either sex. Multiple logistic regression analysis showed that genotype was not associated significantly with hypertension, whereas there was a significant relationship between hypertension and age, family history of hypertension, body mass index, hematocrit, platelet count, gamma-glutamyl transpeptidase (gamma-GTP) and uric acid. Data analysis using one-way analysis of variance and multiple regression showed that the C825T allele had no significant influence on either systolic, diastolic or mean blood pressure. CONCLUSIONS This study indicates that the C825T polymorphism is not a significant factor for hypertension or blood pressures in Japanese people. Targeting of this polymorphism is therefore unlikely to be beneficial when attempting to prevent hypertension in the general Japanese population.

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.

Background and Purpose —Stroke mortality in Japan has significantly declined during recent decades. To determine the cause of this decrease, we studied the trends in stroke incidence and case fatality within 28 days after stroke in a rural area in Japan. Methods —We used a population-based registry during 1977–1991 in Oyabe, a rural area in the central part of Japan. The average population aged 25 years and older numbered 32 859 persons. Changes in age-standardized stroke incidence rate were calculated and compared between the 3 periods 1977–1981, 1982–1986, and 1987–1991. The 28-day case fatality rate was evaluated and also compared between the 3 periods by onset year. Results —The total number of strokes was 2068. The age-standardized incidence rate of all strokes decreased during the 15-year period, from 605 to 417 per 100 000 in men and from 476 to 329 per 100 000 in women. A marked decline was found during 1977–1986 but was not apparent during 1987–1991. Moreover, there was an increase in the group aged 75 years and older. The 28-day case fatality rates for all strokes improved from 18.0% to 14.2% in men and from 26.8% to 19.1% in women during the observation period. Conclusions —These data indicate that declines in the stroke incidence and the 28- day case fatality have been associated with a marked decrease in stroke-related mortality in Japan.

Background: Previous population-based cross-sectional studies have reported modest inverse relations of dietary starch intake and blood pressure (BP). However, studies that have evaluated associations of BP with starchy foods, e.g., rice, potatoes, pasta, bread, are limited. Objective: Data from INTERMAP were used to assess relations between consumptions of starchy foods and BP. Methods: INTERMAP is a cross-sectional epidemiologic study of 4,680 persons ages 40 to 59 years from 17 random population samples in China, Japan, United Kingdom (UK), and United States of America (USA). BP was measured 8 times; data on food and supplement use were obtained from 4 standardized in-depth multi-pass 24-hour dietary recalls and 2 timed 24-hour urine collections. Differences in BP for each food intake higher by two standard deviations (SD) were estimated by multivariable linear regression (2 SD values: rice: 177, pasta: 56, potatoes: 65, bread: 40, sum of these four: 177 g/1,000 kcal). Adjustment for possible confounders was performed sequentially; for age, gender, sample; plus dietary and other lifestyle factors. Results: Rice intake higher by 2SD was associated with systolic/diastolic BP differences of -1.38 /-0.79 mm Hg (p Conclusions: Modest inverse associations were observed with BP and intake of rice and the sum of the four most common starchy foods in four countries. Higher consumption of these starchy foods may contribute modestly to lower blood pressure levels in other populations, and thereby potentially confer preventive benefits regarding hypertension and cardiovascular disease.

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.