[Objective] The purpose of this study was to clarify the risk factors for required long-term care for elderly people.
[Methods] We performed a case control study in a town in Fukuoka Prefecture, Japan. The disabled group consisted of 62 persons with a disability level 4 or 5 (the two highest levels) according to the Long-term Care Insurance categorization. The control group consisted of randomly selected elderly residents who were healthy or needed only limited support, one for each in the disabled group, matching gender and age (within ± 1 year). We obtained the data (including major diseases that caused the disabilities, medical and treatment history, frequency of health checkups, lifestyle habits, personality, and hobbies) from an interview survey conducted in 2001 and 2002 and also referred to the results of health checkups carried out from 1989 to 1993.
[Results] The major diseases causing the disabilities were cerebrovascular disease, dementia and femoral fracture, which accounted for 41.9%, 27.4% and 12.9% of the disabled group, respectively. The risk factors were significantly associated with having a history of treatment for diabetes mellitus (odds ratio=3.54, 95%CI : 1.07-11.76, p<0.05). However, the odds ratio for having a history of treatment for hypertension was 0.82, indicating no increase in the risk. We therefore compared the prevalence of hypertension and its treatment for 22 pairs from both groups who underwent health checkups from 1989 to 1993. As a result, a significantly larger number of hypertensive persons including those who were receiving treatment for the disease were observed among the disabled group (14 ; 63.6%) than among the control group (8 ; 36.4%) (p<0.05). However, there were fewer persons on medication for hypertension among the former (4 ; 28.5%) than among the latter (4; 50.0%). In addition, the disabled group also had fewer health checkups than the control group when the health checkup history was examined for 45 pairs.
[Conclusion] Despite the higher hypertension ratio, the control group had a poorer understanding of the disease, was less compliant with its treatment, and underwent fewer health checkups. Our results suggested that getting regular health checkups would help people to have a better understanding of hypertension and treatment compliance, which in turn would help prevent their conditions from declining into a serious disability requiring long-term care.

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We investigated the significance of coronary calcification detected by helical CT for prevention of ischemic heart disease. We enrolled 2, 879 asymptomatic male workers who had a general health check-up at JR East Health Promotion Center between April 1st, 2004, and March 3lth, 2005. Coronary calcification was detected in 297 cases (10.32%).
We divided them into two groups : 297 coronary calcification positive and 2, 582 negative to study the correlation between coronary calcification and coronary risk factors.
Means between the two groups achieved statistical significance for the evaluation of age, systolic blood pressure, diastolic blood pressure, fasting blood sugar, HbAlc, total cholesterol, and triglyceride. (P<0.05)
The positive rate of coronary calcification in ex-smokers and current smokers was significantly higher than that in non-smokers. (P<0.05)

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Diabetes mellitus (DM) is common in patients with heart failure (HF). However, the prognostic and pathogenic effects of DM on HF have not been clarified. The aim of this study was to evaluate the prognosis and pathogenesis of HF of DM and non-DM patients. From January 2002 to August 2004, 678 patients with HF were admitted to our hospital and they were divided into a DM group (n=128) and non-DM (NDM) group (n=550). The DM had their fasting blood sugar level (FBS≥126mg/dl) evaluated several times. No significant differences were found in age, gender, habit of smoking, hyperlipidemia, hypertension, ischemia heart disease (IHD), valvular heart disease, arrhythmia, medication, NYHA class or BNP. The DM group had a significantly higher body mass index than NDM.The incidences of re-admission were significant increased in DM than in NDM (44% vs 25%, p<0.01). Regarding the reasons for re-admission, uncontrolled hypertension and IHD were significantly higher in DM than in NDM.Concerning echocardiography, no significant differences were found in left ventricular (LV) ejection fraction or LV size. However, the E/A ratio was significantly lower (0.56±0.10 vs 0.78±0.11, P<0.05) and deceleration time was significant longer (262±llmsec vs 224±15msec, P<0.01) in DM than in NDM. These results suggest that DM leads to LV diastolic dysfunction and re-admission for HF and that DM is one of the important factors which mediates the pathogenesis and prognosis of HF.

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A population-based cohort study of hemodialysis patients (The KAREN Study) has been carried out in the northern part of the main island of Japan since 2003. Follow-up studies were completed on 1, 145 patients 2 years after initial registration. The total observation period was 2, 215 patient-years. There were 189 deaths, 214 cases of congestive heart failure, 29 cases of myocardial infarction, and 107 cases of stroke. Crude mortality was 85 (/1000 patient-years). Incident rates of myocardial infarction and stroke were 13.1 and 48.3, respectively. Cumulative mortality was 16.5%. The difference of mortality between men and women was not significant. The mortality rate in patients with diabetic nephropathy was significantly higher than those in patients with other causes of renal failure (log rank p<<0.01). Multivariate adjusted hazard ratios (HR) were determined by Cox regression analysis. Major risk factors for total mortality in hemodialysis patients were age (HR : (95%CI) : 1.047 (1.033-1.062)), diabetes mellitus (1.416 (1.045-1.919)), the presence of hepatitis C virus antibody (1.581 (1.043-2.395)), low levels of serum albumin 2.430 (1.785-3.308), and elevated serum CRP levels (1.944 (1.442-2.621)). These factors independently contributed to increased mortality regardless of serious comorbid conditions such as myocardial infarction, stroke, and/or malignant disease

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[in Japanese]

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[in Japanese]

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[in Japanese]

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