The Iwate Cardiovascular Disease Research (I-CARE) system was developed to allow effective and accurate determination of the prognosis of cardiovascular patients discharged from Iwate Medical University Hospital. To simplify the system, the required base data were obtained from patient summary information at discharge. One year after discharge, data from patient visits to our hospital were loaded from the hospital computer and patient records were obtained from medical institutions that had referred the patients to our hospital. Questionnaires were sent to patients, a telephone survey was conducted for patients who did not reply to the questionnaire, and obituaries in local newspapers were checked. Based on this approach, 1, 065 patients who were discharged and survived for 6 months were followed up and their prognosis one year after discharge was obtained for 99% of these patients, including 62 who died during this period. The mail and telephone surveys were used for only 13% and 6% of the patients, respectively. The major cause of death was malignant neoplasm (23%), suggesting that even patients who are discharged from a cardiovascular unit require follow-up regarding possible cancer onset. In general, our data suggest that use of the I-CARE system permits effective prognosis research with a high follow-up rate.

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[Purpose] To determine regional distribution of risk factors for cardiovascular diseases for inclusion in the promotion of the Health Japan 21, a baseline survey of lifestyles in the area of Kushimoto Public Health Centre was accomplished in 2002.
[Participants and methods] All junior high school boys and girls (n=685) and high school students (n=837) were invited to the one day survey after obtaining individual informed consent. As for adults, a mail survey questionnaire was posted to each inhabitant aged 20 to 69 years old who was randomly selected to constitute 14% of the whole population.
[Results] Response rates were 98% for junior high school students, 86% for high school students, and 53% for adult inhabitants. Around 70% of junior high school students reported experience drinking in alcoholic beverages, and 86% of high school students did, which was 20% higher than those of the nationwide survey in 2000. Current smoking rates of junior high school students were some 10%, and the figure went up continuously to 34% for the 3rd grade male high school students and 16% for female. These figures were almost the same as the nationwide survey and much higher than that of adult women. From the adult survey, men who did not eat breakfast reached more than 20% and women more than 10%, and other lifestyles were also poorer when compared with those of the Japan Collaborative Cohort Study population. Of these, age-adjusted drinking prevalence was 61 % for men, and 30% for women, and smoking prevalence 48% and 10%, respectively. Current smokers had less knowledge regarding active and passive smoking than non-and ex-smokers.
[Conclusion] An integrated health policy that encompasses young adolescent through aged adults is needed for promoting the Health Japan 21 locally, and monitoring these prevalence rates is essential for the evaluation of the policy by a local public health centre.

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[Background and purpose] Silent cerebrovascular lesions are associated with an increased risk of stroke. Although the incidence of cerebral hemorrhage has decreased in Japan, prevalence of cerebral infarction has not decreased. Fibrinogen is a major determinant of plasma viscosity. It is possible that elevated fibrinogen level is associated with the risk of cerebral infarction. We conducted a cross-sectional study to determine the association between plasma fibrinogen and cerebrovascular lesions in a general population.
[Methods] The study population consisted of 662 subjects (32.2% men, mean age 66.6 ± 5.3 years, mean plasma fibrinogen 299.8 ± 63.5 mg/dl) from a general population of rural Japanese community, Ohasama. We evaluated the association between plasma fibrinogen and silent cerebrovascular lesions [number of lacunar infarction and extent of periventricular hyperintensity (PVH)] detected by MRI.
[Results] Fibrinogen levels were significantly higher in subjects with multiple lacunar infarctions. Each 1SD (63.5 mg/dl) increase in fibrinogen was significantly associated with an increase in the risk of lacunar infarction (OR=1.29, 95% CI : 1.09-1.53) after adjustment for age, sex, smoking status, drinking status, use of antihypertensive medication, BMI, 24-h ambulatory blood pressure (24-h ABP), and a history of hypercholesterolemia, diabetes mellitus or atrial fibrillation. Twenty-four hour ABP was also significantly and independently associated with lacunar infarction. Even when 24-h ABP values were within the normal range (<135/80 mmHg), elevated fibrinogen levels were associated with an increased risk of lacunar infarction. There was no association between fibrinogen and PVH.
[Conclusion] The present results demonstrated that fibrinogen was strongly associated with risk of lacunar infarction, suggesting that fibrinogen is an independent risk factor or predictor for lacunar infarction.

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[in Japanese]

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[in Japanese]

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