Search

Daiji Nagayama,1,2 Kentaro Fujishiro,3 Kenji Suzuki,3 Kohji Shirai4 1Department of Internal Medicine, Nagayama Clinic, Tochigi, Japan; 2Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, Chiba, Japan; 3Research and Development Division, Japan Health Promotion Foundation, Tokyo, Japan; 4Internal Medicine, Mihama Hospital, Chiba, JapanCorrespondence: Daiji Nagayama, Nagayama Clinic, 2-12-22, Tenjin-Cho, Oyama-City, Tochigi, 323-0032, Japan, Tel +81-285-22-0219, Fax +81-285-22-0219, Email deverlast96071@gmail.comAbstract: Cardio-ankle vascular index (CAVI) was developed to reflect the stiffness of the arterial tree from the aortic origin to the ankle. This arterial stiffness parameter is useful for assessing the severity of cardiovascular disease (CVD) and its risk. However, compared to pulse wave velocity (PWV), the conventional gold standard of arterial stiffness parameter, there has been a concern regarding CAVI that there are fewer longitudinal studies for CVD. Furthermore, the accuracy of CAVI for atherosclerotic diseases compared to other parameters has not been well validated. This review article aims to summarize recent findings to clarify the predictive ability of CAVI in longitudinal studies. First, several large longitudinal studies have found that not only baseline CAVI but also CAVI changes during the observation period predict cardiovascular events. Second, CAVI may have superior discriminatory power for all-cause mortality and major adverse cardiovascular endpoints compared to PWV. Furthermore, one large longitudinal study found CAVI to be a stronger predictor for renal function decline compared to PWV as well as CAVI0, a variant of CAVI that mathematically excludes BP dependence. Additionally, CAVI shows the properties that allow the elucidation of specific hemodynamics in aortic valve disease or hypovolemia. In conclusion, CAVI may be a modifiable arterial stiffness parameter not only for predicting and preventing atherosclerotic diseases but also for elucidating specific hemodynamic pathophysiology.Keywords: cardio-ankle vascular index, pulse wave velocity, CAVI0, longitudinal study, cardiovascular disease, renal function decline

Daiji Nagayama,1,2 Kentaro Fujishiro,3 Keijiro Nakamura,4 Yasuhiro Watanabe,2 Takashi Yamaguchi,2 Kenji Suzuki,3 Kazuhiro Shimizu,5 Atsuhito Saiki,2 Kohji Shirai6 1Department of Internal Medicine, Nagayama Clinic, Tochigi, Japan; 2Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, Chiba, Japan; 3Japan Health Promotion Foundation, Tokyo, Japan; 4Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan; 5Division of Cardiovascular Medicine, Toho University, Sakura Medical Center, Chiba, Japan; 6Department of Internal Medicine, Mihama Hospital, Chiba, JapanCorrespondence: Daiji NagayamaNagayama Clinic, 2-12-22, Tenjin-Cho, Oyama-City, Tochigi, 323-0032, Japan, Tel/Fax +81-285-22-0219, Email deverlast96071@gmail.comAim: Physiological tests to assess systemic vascular function are not included in the risk score for atrial fibrillation (AF). We aimed to examine whether cardio-ankle vascular index (CAVI), a systemic arterial stiffness parameter, is associated with the presence of AF in Japanese general population.Methods: A cross-sectional study (N = 47,687) and a cohort study (N = 5418, four consecutive years) in Japanese urban residents who participated in annual health screening were conducted.Results: A total of 164 subjects (0.34%) had AF in the cross-sectional data. After propensity score matching for age and gender, logistic regression analysis revealed that CAVI is independently associated with AF, as are body mass index and estimated glomerular filtration rate. In a 4-year cohort study, 22 subjects (0.41%) with new-appearance of AF showed higher CAVI at baseline than those without. In the receiver-operating-characteristic curve analysis, the area under the curve, which is a measure of predictability, of CAVI for the new-appearance of AF was 0.747, and the cut-off value of CAVI was 8.0. Kaplan–Meier analysis revealed that the cumulative incidence of new-appearance of AF was higher in subjects with CAVI ≥ 8.0 compared to those with CAVI < 8.0. In Cox-proportional hazards analysis, CAVI ≥ 8.0 as well as gender were identified as independent predictors for the new-appearance of AF, whereas age ≥ 65 years was not.Conclusion: Increased CAVI may represent a major modifiable risk factor for the development of AF. Studies are needed to confirm that CAVI is a predictor of AF independent of various AF risk factors and that CAVI-lowering interventions can prevent new-appearance or recurrence of AF.Keywords: atrial fibrillation, cardio-ankle vascular index, CAVI, arterial stiffness, health screening

Background: This retrospective observational study aimed to examine whether clinical inflammatory parameters were associated with the requirement dosage of unfractionated heparin (UFH) to maintain the range of ACT in veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during lung transplantation surgery. Methods: Among all patients who underwent lung transplantation using V-A ECMO from January 2021 to May 2022, 27 patients were included. These patients were divided into two groups based on whether the infusion rate of UFH was increased from the initial infusion rate (7–8 units/kg/h) (increased group, n = 10) or the infusion rate was maintained or decreased (non-increased group, n = 17). The infusion rate was adjusted with an activated clotting time (ACT) target of 160–200 s. Results: At 1–2 h after starting ECMO, ACT was significantly lower (179.0 (166.5–188.5) versus 224.0 (193.0–242.0) sec, p = 0.006) and white blood cell (WBC) counts were higher in the increased group (12.6 ± 3.3 versus 9.5 ± 4.0 × 103/μL, p = 0.046). The UFH infusion rates were higher in the increased group during the surgery. The cutoff value of WBC count at 1–2 h after starting ECMO for discriminating the need for increasing the UFH dosage was determined as 10.2 × 103/μL (sensitivity 90.0%, specificity 58.8%, area under the curve 0.712) and discrimination of this cut-off value was confirmed as statistically significant (p = 0.018). Conclusion: These data suggested that WBC count was associated with the requirement of an increase in the UFH infusion rate of V-A ECMO during lung transplantation surgery. Further evaluation is necessary to clarify the role of WBC count in determining the optimal UFH dosage.

The paper explores how paid and unpaid labor history over the life course influence women's cardiovascular disease. U.S. women comprise about 50% of the paid workforce and perform the majority of unpaid labor. However, the influence of women's work on their health is under-researched. Our sample was drawn from the Women's Health Initiative Observational Study, a cohort of post-menopausal women in the U.S. aged 50–79 at recruitment. Women were categorized into five groups according to paid labor history: worked in paid jobs consistently throughout adult life; left the workforce early; entered the workforce later; discontinuous work history; never worked outside the home. Live birth history (none, at least one, missing) served as a proxy for unpaid labor in prime age. Cox proportional hazard models were used to estimate the hazard ratio of CVD associated with different paid work histories. We then assessed the effect of unpaid labor on the relation between paid labor and CVD. Paid labor participation was not associated with CVD risk among women without unpaid labor after adjusting for age, education, and birth cohort. Among those with unpaid demands, leaving the workforce early or having discontinuous work history was protective. In this U.S. sample, the association between paid work participation history and CVD risk depends on the presence of unpaid labor. Our results demonstrate the necessity of including work – paid and unpaid – in consideration of women's health. [ABSTRACT FROM AUTHOR]

Objectives: Long working hours may be associated with cardiovascular disease (CVD). The objective was to investigate cross-sectional associations of work hours with carotid intima-media thickness (CIMT) and ankle-brachial index (ABI).Methods: Participants were 1694 women and 1868 men from the Multi-Ethnic Study of Atherosclerosis. CIMT and ABI were measured using standard protocols. Information on work hours was obtained from questionnaires. Mean values of CIMT and ABI were examined across five categories of hours worked per week (≤20, 21-39, 40, 41-50 and >50) using analysis of variance/analysis of covariance. p Values for trend were obtained from linear regression models.Results: Mean age of participants was 56.9±8.4 years; 52.4% were men. Distinct patterns of association between work hours and the subclinical CVD biomarkers were found for women and men, although this heterogeneity by gender was not statistically significant. Among women only, work hours were positively associated with common (but not internal) CIMT (p=0.073) after full risk factor adjustment. Compared with women working 40 h, those working >50 h were more likely to have an ABI <1 (vs 1-1.4) (OR=1.85, 95% CI 1.01 to 3.38). In men, work hours and ABI were inversely associated (p=0.046). There was some evidence that the association between work hours and ABI was modified by occupational category (interaction p=0.061). Among persons classified as management/professionals, longer work hours was associated with lower ABI (p=0.015). No significant associations were observed among other occupational groups.Conclusions: Working longer hours may be associated with subclinical CVD. These associations should be investigated using longitudinal studies. [ABSTRACT FROM AUTHOR]

Abstract: The association between socioeconomic status (SES) and health has been widely documented. However, the role of occupation in this association is not clear because occupation is less often used than income and education as an indicator of SES, especially in the United States. This may be caused by the ambiguity in what occupation represents: both health-enhancing resources (e.g., self-affirmation) and health-damaging hazards (e.g., job stress). SES has two aspects: resources and status. While income and education represent resources and imply status, occupational prestige is an explicit indicator of the social status afforded by one’s occupation. Using data from the US General Social Survey in 2002 and 2006 (n = 3151), we examine whether occupational prestige has a significant association with self-rated health independent from other SES indicators (income, education), occupational categories (e.g., managerial, professional, technical, service), and previously established work-related health determinants (job strain, work place social support, job satisfaction). After all covariates were included in the multiple logistic regression model, higher occupational prestige was associated with lower odds of reporting poor/fair self-rated health. We discuss potential mechanisms through which occupational prestige may impact health. Our findings not only suggest multiple ways that occupation is associated with health, but also highlight the utility of occupational prestige as an SES indicator that explicitly represents social standing. [ABSTRACT FROM AUTHOR]

A small but growing literature has documented an association between justice at work and employee health. However, the pathways and mechanisms underlying this association are not well understood. This article proposes a conceptual framework that bridges the organizational justice, occupational stress, and occupational epidemiology literatures. Justice appraisals are proposed to be both important mediators and moderators in the causal flow from exposure to the organizational environment to employee health. The potential role of justice in enhancing employee health is compared to that of the well-established concepts of social support and job control. Directions for future research are suggested, along with strategies for overcoming challenges inherent in this multidisciplinary area of research. Implications for work-site health interventions are discussed. [ABSTRACT FROM AUTHOR]

While racial discrimination has gained increasing attention in public health research, little is known about perceived racial privilege and health. Using the Behavioral Risk Factor Surveillance System (BRFSS) data, this study explored the relationship of both perceived racial discrimination and privilege with well-being in the USA. Data were extracted from the BRFSS 2004 data set, in which 22,412 respondents in seven states and one major city provided data on perceived racial discrimination and privilege at work. Logistic regression analysis was conducted to examine the relationships of differential racial treatment to self-rated general health status and the number of physically and mentally unhealthy days. Racially stratified analyses found that perceived racial privilege was significantly associated with more days of poor physical and mental health. This relationship was consistent for Whites, but for racial minorities it appeared on only some outcome measures. Reports of being treated worse than other races in the workplace were associated with poor health for all racial groups, as had been reported in previous studies on racial discrimination. Because racial discrimination and racial privilege are both products of racism, this study's findings suggest that racism may harm all involved. Impacts of perceived racial privilege deserve more attention in the literature on racism and health. [ABSTRACT FROM AUTHOR]

Objectives: Lifestyle has a major influence on the development and progression of atherosclerosis. Our motto for healthy habits is "give up one, reduce two, and increase three". The one thing that is to be given up is smoking. The two things that are to be reduced are intake of food and alcohol. The three things that are to be increased are exercise, rest and enjoyable activities. We assessed correlation between these six health habits and plaque score indicating degree of atherosclerosis in the carotid artery.Methods: Subjects were divided into unfavorable (practicing zero to three habits) and optimal (practicing four to six habits) healthy habits groups.Results: Plaque score was significantly higher in the unfavorable group (7.6 +/- 5.8) than in the optimal group (4.9 +/- 4.2) (P<0.001).Conclusions: The healthy habits that significantly contributed to prevention of atherosclerosis were quitting smoking and increasing rest and enjoyable activities. [ABSTRACT FROM AUTHOR]