Objectives: In the past few decades, there have been changes in public health policies related to prevention and clinical management of hypertension including publication of guidelines that defined normal blood pressure as systolic blood pressure (SBP) <120 mmHg and diastolic blood pressure (DBP) <80 mmHg and emergence of novel antihypertensive drugs. However, few recent studies of which baseline surveys were conducted after 2000 have examined the association of blood pressure using the recent normal blood pressure category as the reference with the incidence of cardiovascular diseases (CVD) and its subtypes i.e., stroke and coronary heart disease (CHD). This study aimed to examine the association between blood pressure categories and the risk of incidence of CVD and its subtypes (stroke and CHD), and calculate the Population Attributable Fraction (PAF) in a recent Japanese working population.

Methods: We studied 4,824 subjects (3,884 men and 960 women) aged ≥ 35 years without histories of CVD who participated in the 2007 baseline survey of the Aichi Workers' Cohort Study. Blood pressure was classified into four groups as follows: normal (SBP <120 mmHg and DBP <80 mmHg), high-normal/elevated (SBP 120-139 mmHg and/or DBP 80-89 mmHg), stage 1 hypertension (SBP 140-159 mmHg and/or DBP 90-99 mmHg), and stage 2/3 hypertension (SBP ≥ 160 mmHg and/or DBP ≥ 100 mmHg). Cox model was used to estimate the hazard ratios (HRs) of stroke, CHD and CVD adjusted for age, sex, body mass index, smoking status, physical activity, alcohol intake, sleep duration, and current/past medical treatment of hypertension, diabetes, and hyperlipidemia. The PAF was estimated using the multivariable-adjusted HR.

Results: Stage 1 hypertension and stage 2/3 hypertension were significantly associated with an increased risk of stroke and CVD events. The multivariable-adjusted hazard ratios of stage 1 hypertension for stroke and CVD were 2.39 and 2.15, and the corresponding hazard ratios of stage 2/3 hypertension for stroke and CVD were 4.88 and 3.05, respectively. In contrast, only stage 1 hypertension was significantly associated with an increased risk of CHD events (HR: 2.01). The highest PAFs for stroke, CHD, and CVD were observed in stage 1 hypertension (PAF range: 16.1-16.6).

Conclusion: Stage 1 hypertension was significantly associated with CVD and its subtypes, whereas stage 2/3 hypertension was significantly associated with stroke and CVD. Stage 1 hypertension showed the highest PAF for these outcomes.

Objective: Gratitude, a central element of positive psychology, is closely linked to social engagement; however, few studies have examined the relationship between gratitude and lifestyle-related diseases. This study aimed to investigate the association among Japanese community-dwelling older adults.

Methods: The Japan Gerontological Evaluation Study (JAGES) 2019 survey included 23,554 community-dwelling adults aged 65 years or older who were not receiving long-term care. Among them, 22,400 individuals for whom information on lifestyle-related diseases was available were included in the analysis. The frequency of gratitude expression was assessed by the question: "How often do you have opportunities to say ‘thank you' to people around you in your daily life?" (several times a day, once a day, several times a week, and almost never) . Lifestyle-related diseases—including hypertension, diabetes, dyslipidemia, depression, stroke, heart disease, cancer, dementia, respiratory, and digestive diseases—were identified through self-administered questionnaires. Logistic regression models were used to calculate age- and sex-adjusted and multivariable-adjusted odds ratios and 95% confidence intervals for each disease, with "several times a day" as the reference group. Analyses were also stratified by sex and frequency of social interaction. Covariates included sex, age, BMI, alcohol consumption, smoking, and physical activity.

Results: Overall, 32% reported expressing gratitude several times a day. Compared with this group, those who "almost never" had higher odds ratios (95% CI) of hypertension, (1.07 [1.00-1.15]) , diabetes (1.10 [1.00-1.22]) , depression (2.49 [1.65-3.77]) , dementia 1.65 [1.02-2.66]) , respiratory disease 1.16 [1.00-1.36]) and digestive disease (1.24 [1.06-1.44]) . The odds of cancer were lower (0.75 [0.63-0.90]) . In sex-stratified analyses, men showed higher odds ratios for depression, dementia, respiratory and digestive disease, while women showed higher odds ratios for diabetes and depression. Among those who frequently met others, higher odds ratios were shown for hypertension, depression, and dementia, and lower for cancer.

Conclusion: This large community-based study is the first to demonstrate that lower frequency of expressing gratitude is associated with a higher prevalence of lifestyle-related diseases. The associations were evident among men and those with frequently met others. Further longitudinal and interventional studies are warranted to clarify causal mechanisms and potential preventive implications.