The presence of systematic errors caused by terminal digit preference was examined in the blood pressure measurement of 9696 female subjects (40 to 69 years old) who participated in general health examinations for the elderly conducted by 195 municipalities extracted from all prefectures in 2000. Terminal digit preference equality was tested for even numbers with normal mercury sphygmomanometer and for 0 to 9 with automated blood pressure measurement devices. The results were as follows;
1) In 6560 subjects, both systolic and diastolic blood pressure values by mercury sphygmomanometer had a significant high frequency of terminal digit preference for zero (χ²=772, p<0.001, χ²=1855, p<0.001, respectively).
2) In 2919 both systolic and diastolic blood pressure terminal digit preference equality by automated blood pressure measurement devices was denied for 0 to 9 (χ²=53.4, p<0.001, χ²=72.9, p<0.001, respectively), and even terminal digit numbers occurred more frequently than odd numbers significantly (χ²=36.6, p<0.001, χ²=38.4, p<0.001, respectively).
3) When terminal digit zero readings of this 2000 survey were compared with the 1985 survey for both systolic and diastolic blood pressure readings, the rate of zero readings in even numbers were decreased from 41.1% to 33.7% for systolic and from 45.5% to 41.5% for diastolic.
Because of the classification of blood pressure levels which have usually a boundary value of terminal digit of zero for example 140-159 mmHg or 90-99 mmHg, the difference of the rate of zero in measured values have an influence on the prevalence of hypertension

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The aim of this study was to assess the relationship of pulse wave velocity (PWV) and carotid atherosclerosis evaluated by high-resolution B-mode carotid ultrasonography. The subjects consisted of 75 patients (Male 54, mean age 61years old). The mean common carotid intima-media thickness (IMT) was measured and patients with max intimamedia thickness≥ 1.1mm were diagnosed as having carotid atherosclerosis. The heart-carotid PWV (CAPWV) and heart-femoral PWV (CFPWV) were automatically measured by Japan COLIN AT-Form. The carotid atherosclerosis was significantly positively correlated with CAPWV and CFPWV, respectively. When the number of risk factors, increased carotid IMT and CFPWV increased significantly. Using 916cm/s of CAPWV and 900cm/s of CFPWV as cutoff values, the patients were categorized into normal and pathologic groups. The Odds Ratios for coronary artery disease of carotid atherosclerosis and CFPWV were 5.04 (p=0.006) and 2.03 (p=0.180), respectively. Both B-mode ultrasonography and PWV are useful assessment methods for atherosclerosis. Moreover, carotid ultrasonography may be a useful augmentary method for diagnosis of coronary artery disease.

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In Japan, death rates for cardiovascular disease have been increasing especially in the elderly. The presentation of coronary atherosclerosis in the elderly is the result of decades of progression of the pathologic process due to coronary risk factors, as the prevalence of coronary risk factors like hypertension, glucose intolerance, and hyperlipidemia increases with advancing age. Moreover the vulnerability of mental stress in the elderly is higher than that in the young as well as the social stress to the elderly is more severe than that in the young. Inversely, patients older than 100 years of age are relatively free of coronary artery disease because of natural selection resulting from earlier death of the more severe cases. Life-span is regulated by heredity whether people can escape coronary artery disease or not. According to some clinical trials, medical control of coronary risk factors is effective in preventing coronary artery disease even in the elderly. Therefore, overcoming coronary artery disease may make people, who may have suffered from coronary artery disease in the future otherwise, obtain a longer life-span. However, quality of life, and the view of life and death should be considered, when the elderly are treated especially in face of an aging society.

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Referring to the results from various epidemiological studies in the world which have been conducted in the laterhalf of the 20th century, I have tried to review current status of the preventive cardiology, and consider prospects of the strategy for the prevention of cardiovascular diseases in the coming new century.
Although mortality from cerebrovascular disease (CVD) has been constantly reduced in Japan, CVD has still a higher incidence than coronary heart disease (CHD) for the current Japanese based on the data from cohort or registration studies in Japan. The long-term prospective study in Japan revealed that reduction-rates of CVD incidence get a slow-down since the middle of 1980s. This could be due to prevailing management of hypertension and increasing proportion of elderly population. Risk factors for CVD would be roughly divided into those related to hypertension and those associated with atherosclerosis. The former mainly affects the occurrence of intracerebral hemorrhage and lacunar stroke, and the latter has an effect on the incidence of cerebral embolism and the development of carotid atherosclerosis.
Risk factors for CHD are not so much different between Japanese and Caucasian. A difference in the prevalence of risk factors could contribute to the great difference in the incidence of CHD between the two. Diabetes mellitus, however, is recently emerging as an important risk factor of CHD for Japanese, which could accelerate atherosclerosis together with obesity, hyperlipidemia and hypertension through hyperinsulinemia.
Estrogen, inflammation and homocysteine were taken and reviewed in association with the advancement ofatherosclerosis. Lipid metabolism, coagulation and fibrinolysis, cytokine-network and nutrition were basically related in each other and the sum of all etiologies advances atherosclerosis.
The Randomized Clinical Trial (RCT) on the treatment of hypertension, hyperlipidemia and diabetes mellitus has been seemingly to be successful in the primary and secondary prevention of cardiovascular disease, but there have been, unfortunately, no data specialized to the Japanese.
A search to find the associated gene with cardiovascular disease (single nucleotide polymorphism, SNP) is going to be widely favoured. This will be one of important tools for prevention of cardiovascular disease in the 21st century, because of the connection with order made medicine if utilizing thrifty gene. But gathering individual basic information and establishing standardized guideline of bioethics are essential to lead studies to the success.

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