Guidelines for the management of hypertension 2019 in Japan (JSH2019) proposes that home blood pressure or ambulatory blood pressure other than office blood pressure provide useful information for the management of hypertension. The JSH2019 renamed the categories of blood pressure levels <140/90 mmHg (i.e., normal blood pressure, high normal blood pressure, and high blood pressure). Differ from the previous guideline, in subjects with high normal/high blood pressure, the lifestyle modifications are recommended. In the initial plan of the management of hypertension, age ≥65 years old, male, current smoking, dyslipidemia, diabetes mellitus, history of cardiovascular disease, non-valvular atrial fibrillation, proteinuria were proposed as markers for the risk assessment. In hypertensive subjects with high risk, the medical treatment for hypertension is recommended immediately.

 Although bone mineral density (BMD) measurements at the lumbar spine and/or the proximal femur using dual energy X-ray absorptiometry (DXA) are recommended for the diagnosis of osteoporosis, DXA measurements at the distal radius are often performed instead for the medical checkup in Japan. Therefore, we evaluated the validity of distal radius DXA as an osteoporosis screening test.

 Thirty women who were identified with a low BMD during their medical checkup underwent BMD measurements at the distal third radius (RADIUS), the lumbar spine (SPINE) and the proximal femur (HIP) within the duration of one year. The median age of the subjects was 64 years (49–87 years). The correlation and difference between the BMD values in the different regions were retrospectively assessed by comparing the percentage difference from the young adult mean (%YAM).

 The %YAM of RADIUS was significantly correlated with those of SPINE and HIP (r=0.6055, p=0.0004 and r=0.5490, p=0.0017, respectively). The %YAM of RADIUS was, however, significantly lower than those of SPINE (p<0.0001, mean difference 10.13 points, 99% CI 5.22–15.05) and HIP (p<0.0001, 9.53, 4.44–14.62). By contrast, %YAMs of SPINE and HIP were statistically not different (p=0.7100, 0.60, −3.80 to 5.00). According to the significant low %YAM of RADIUS, the false-positive rate was 33.3% and 25.3% for osteopenia in SPINE and HIP, respectively. The %YAMs of RADIUS, SPINE and HIP were comparably correlated with the FRAX 10-year major osteoporotic fracture probability (r=−0.6292, −0.5498, −0.5864, respectively).

In conclusion, DXA at the distal radius may be an acceptable alternative for osteoporosis screening. However, it should be performed with caution, because this test has a relatively high false-positive rate. If the medical facilities allow for it, SPINE and/or HIP are recommended.

 Brain Dock is a comprehensive battery of medical tests that can detect occult pathologies such as unruptured aneurysms, tumors and asymptomatic brain infarctions. Its primary aim is to prevent stroke. We investigated Brain Dock findings of 50 Lion Corporation employees at Juntendo Tokyo Koto Geriatric Medical Center between January 2015 and December 2017. We compared the risk factors of hypertension, diabetes, hyperlipidemia, atrial fibrillation, chronic kidney disease and obesity between employees with and without abnormal MRI and MRA findings. We found that 18 (36.0%) of the employees had asymptomatic cerebral infarctions. The incidence of asymptomatic cerebral infarction increases with advancing age, and hypertension, whether treated or not, was a significant risk factor. These results were similar to those of previous reports. However, the fact that over 50% of assessed employees had some abnormal findings is notable. We recommend that all employees aged more than 50 years old should undergo cerebral assessments. In addition, more lectures and information about occupational health are needed in the workplace to educate employers and employees about cerebrovascular disease prevention, and how to prevent severe cerebral infarction.

 Hemoglobin A1c (HbA1c) is a tool widely used to diagnose or monitor long-term glycemic control in diabetic patients. However, there are hemoglobin (Hb) gene variants or modifications that may affect the accuracy of the A1c value yielding a false high or false low A1c result. HbA1c measurements were performed on an ion exchange HPLC instrument Tosoh HLC-723G11 automated analyzer [Standard mode]. Chromatograms were reviewed for 104,316 samples run in the months of August 2016 to July 2017. All the samples came from a comprehensive medical examination. A total of 43 samples were visually inspected for abnormal patterns suggesting the presence of hemoglobin variants. With support of Tosoh Corporation, all 43 samples underwent additional investigation on the conventional HPLC system with a 40 minute elution time in order to determine the Hb Variant. Based on the results of the additional investigation a total of 43 suspected variants were classified into 4 groups (A~D) according to the chromatographic pattern. Comparison to the results between the G11 and the Affinity Mode additional testing, the G11 showed 38 False low results (88.4%) and 5 False high results (11.6%). Since the result of the additional investigation suggests an interference of the hemoglobin variants in a total of 43 samples, a detection ratio of the hemoglobin variant in this population is 0.041%. It is important to have a better understanding of the HPLC method and characteristics of the variant samples on the method. Also routine inspection of the chromatogram for abnormal peaks, high HbF result and balance compared to related chemistry or hematology testing by the technician will improve the quality and accuracy of the report.

 Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death in Japan. In order to prevent ASCVD, "Specific Health Checkups and Specific Health Guidance" was initiated in 2008, and "Comprehensive Risk Management Chart to Prevent ASCVD 2015 (Chart 2015)" was issued in 2015 by 12 Japanese medical societies and Japanese medical association.

 Many factors contribute to the initiation and progression of ASCVD; thus, even in the same age and gender, the absolute risk for ASCVD differs depending on the existence or the degree of these risk factors. Western countries have utilized risk engine to assess absolute ASCVD risk from before; in Japan, Japanese Atherosclerosis Society adopted "NIPPON DATA 80" as a risk engine for absolute risk assessment in 2012, which was utilized also in "Chart 2015". In 2017, "NIPPON DATA 80" was replaced by "Suita Score", a more adequate tool for current Japanese ASCVD situation than "NIPPON DATA 80".

 Health Check facilities have to allocate health examinees in three categories "Clinic Visit Encouragement", "Health Guidance" and "Follow up in the next year" depending on the test results. As for lipid data, it does not make sense to use the fixed values for all the examinees to allocate in the three categories, because the target lipid values differ according to the absolute risk of the examinee. On the other hand, all the data of health examinees are input in the database; thus, once the program was designed to calculate absolute risk in accordance with "Suita Score", it is easy to allocate the examinees in three categories. The present article overviews "Suita Score" in light of "Chart 2015" and other governmental recommendations, mentions the advantages when we adopt"Suita Score" in the health check, and also proposes TG screening values for the allocation of the examinees.

 Our society has conducted "Health statistics of examination clients A" for 3 years which analysed their health characteristics for understanding suitable health examinations.

 The survey conducted on 2016 revealed wide variations of prevalence rate concerning lipid metabolism based on over 200 institutes and over 1,560 thousands clients data.

 Council for cardio-cerebral vascular diseases united 14 professional academic associations developed a comprehensive risk management chart 2019 for guidelines for prevention of arteriosclerosis diseases.

 This committee conducted analysis for epidemiological characteristics based on this guidelines.

 We conducted individual risk assessment for lipid metabolism based on "Suita" score and target levels of lipid profiles.

 Application of this guideline for assessment of lipid metabolism in health examinations might be useful tools for personal preventive activities and public health activities through "data-health" programs.

 The background for this study is as follows: 1) A negative correlation has been found between fish intake and the onset of myocardial infarction. 2) Effects of fish consumption on the cardio-metabolic risk factors (cardio-metabolic risk: atherosclerosis-inducing risk factors caused by visceral obesity, such as hypertension, dyslipidemia, abnormal glucose tolerance, and metabolic syndrome) remain largely unknown. 3) It has been suggested that dietary fish consumption may be associated with improvement of the overall lifestyle and reduction of the cardio-metabolic risk. Based on this background, we attempted to reveal the effects of fish intake on the cardio-metabolic risk from various standpoints in subjects undergoing health checkup, using two study methods (cross-sectional and longitudinal studies), and evaluate the preventative effects of fish consumption on atherosclerotic cardiovascular disease. Once the effect of fish consumption on the cardio-metabolic risk is clearly demonstrated, diet therapy, especially proactive fish consumption, could be widely adopted. Furthermore, enriching the awareness of society about the importance of diet modification to prevent cerebro-cardiovascular diseases would lead to progress in the fields of preventive medicine. In this paper, we introduce the scientific background for this study, our study hypothesis, and the study protocol of this study. This is a report of the study design and rational for this study.