[Objective] Oxidised low-density lipoproteins (LDL) have drawn attention as factors associated with the development and progression of arteriosclerosis. We measured malondialdehyde-modified LDL (MDA-LDL), an oxidised LDL, in asymptomatic health check-up recipients and compared the levels with carotid ultrasonography results, to assess the usefulness of MDA-LDL for health checkups. [Subjects] Out of 525 brain check-up recipients at the Kanto Rosai Hospital Medical Screening Center in October 2009 and from January to December 2010, 203 men and 135 women, excluding those with a past history of cerebrovascular or coronary artery diseases, were studied. [Methods] We examined MDA-LDL, LDL-cholesterol, high density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglyceride levels, as well as MDA-LDL levels divided by each lipid level. Plaques detected by carotid ultrasonography were classified into 4 groups according to internal characteristics and surface structure: soft, intermediate, hard and ulcer. Cases without plaques served as the control group. We thus compared differences in test values among a total of 5 groups. [Results] The soft group, with plaques considered to have a soft internal lipid core, tended to have higher MDA-LDL levels and lower HDL-C levels than the control group. Moreover, relative levels of MDA-LDL, i.e. divided by each lipid level, tended to be higher in the soft than in the control group. [Conclusion] Our results suggest that the degree of arteriosclerosis may not be sufficiently assessed only by LDL and TC levels. Even in asymptomatic subjects undergoing health check-ups, measurement of MDALDL along with other lipids may allow more precise assessment of the degree of arteriosclerosis and contribute to providing lifestyle guidance and individually tailored treatments for those receiving health check-ups.

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 Cancers have been the leading cause of death in Japan since 1981, and the number of deaths is still increasing. Therefore, the prevention of the disease is the most important issue for health care. Although screening is the fundamental measure to counter cancer, examination rates of those being screened have been low. Then, Japanese government launched the Basic Plan based on the established Cancer Control Act in 2006 in which a goal was that examination rates of screening-tests increased to 50% in order to reduce cancer deaths. In the present study, we estimated how lessen the death rate of cancer, especially lung cancer and calculated the cost for cancer-screening tests, when the rate of screening would go up. The medical fees and the national income by the improved five-year survival rate were also estimated when early detection could be attained. The national income would increase about 1.6 billion yen, if examination rates in cancer-screening tests and the discovery rate of the lung cancer could be improved to 50% and 0.1%, respectively. The national income would increase about 0.2 billion yen, if working percentage would be 27%, and examination rates in cancer-screening tests and the discovery rate of the lung cancer could be improved to 50% and 0.5%, respectively.

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 Purpose: To evaluate endothelial function by digital reactive hyperemia peripheral arterial tonometry (RH-PAT) in health evaluation and promotion.
 Method: We studied 120 apparently healthy Japanese men (53±9 years) who visited the Health Care Center, Chunichi Hospital. No subject had any history of cardiovascular disease and were taking any medication. Endothelial function was assessed by digital RH-PAT, expressed as the reactive hyperemia index (RHI), utilizing Endo-PAT2000 (Itamar Medical, Caesarea). In addition to routine health examinations, we measured apolipoprotein B100, fasting insulin, and high-sensitive CRP levels.
 Results: RH-PAT was successfully measured within 30 minutes in all subjects. The mean value of RHI was 1.76±0.41. RHI was inversely correlated with age, heart rate, hemoglobin A1c, apolipoprotein B100, total cholesterol, LDL cholesterol and non HDL cholesterol. Smoking history and fasting glucose levels showed modest but not significant negative correlations with RHI. In stepwise multiple regression analysis, age, LDL cholesterol and heart rate were found to be independent determinants of RHI.
 Conclusions: Endothelial function evaluated by RH-PAT was related to risk factors of cardiovascular disease. RH-PAT may be a potential surrogate marker for initial stage of atherosclerosis.

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[in Japanese]

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 The number of people afflicted with diabetes mellitus is increasing rapidly in Japan. Obesity associated with deteriorated life style is an important predictor and cause of diabetes mellitus. According to national survey, amount of exercise is decreasing in both men and women in Japan. Life style modification is mandatory to prevent diabetes and to control hyperglycemia in diabetic patients. DCCT and UKPDS successfully demonstrated that glycemic intervention leads to the prevention of microvascular complications. UKPDS80 demonstrated that early intervention in glycemia have long term beneficial effects in the prevention of microvascular and macrovascular complications. Early intervention seems to be very important in treating patients with diabetes mellitus. HbA1c value is going to be changed from JDS to NGSP value from April 1^st, 2012.

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Coronary artery disease incidence and mortality are far lower in Japan as compared to Western countries, Japanese guideline for LDL cholesterol is stricter than those of Western countries for the purpose of maintaining low CAD incidence and mortality. Therefore, improve lifestyle habits becomes a basic treatment strategy. In case of drug use, side effects should be carefully checked. The revised guideline 2012 is based on the concept of absolute risk. Non HDL cholesterol will be evaluated secondarily in hypertriglyceridemia, and management of risk factore other than LDL cholesterol will be emphasized.

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 Revised version of the Guideline for the Management of Hyperuricemia and Gout,2^nd edition has been delivered in jan. 2010. Followings are the main point of guidelines: (1)Hyperuricemia is a major pathogenic factor for urate deposition diseases (gouty arthritis, renal disorder, etc.). It is defined as a disease condition showing a serum urate level exceeding 7.0mg/dl, regardless of sex and age. (2)In women, the risks of lifestyle-related diseases increase with increase in serum urate level, even when it is not more than 7.0mg/dl. Examination for possible underlying diseases and lifestyle guidance should be given; however, drug therapy with urate-lowering drugs is not indicated. (3) Hyperuricemia is broadly classified into the following 3 types: uric acid-overproduction type, uric acid-underexcretion type and combined type. The uric acid clearance rate and creatinine clearance rate are determind for the classification. (4) Hyperuricemia and gout are lifestyle-related diseases. Education and proper guidance aimed at modifying the patients lifestyle play a crucial role in improving the clinical course of the disease with or without drug therapy. (5) Lifestyle modification consists of three parts: nutrition therapy, restriction of alcohol consumption, and recommendation for physical training. Modest weight loss has been shown to reduce serum urate level.

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