Carotid atherosclerosis and cardiovascular risk factors: a comparison of residents of a rural area of Okinawa with residents of a typical suburban area of Fukuoka, Japan


      Areas of Japan are known worldwide for the longevity of their residents. Okinawa has the highest longevity in Japan and a low rate of death due to cardiovascular disease. We investigated carotid atherosclerotic (CA) risk factors in islands of I city in Okinawa prefecture and compared them with K town, a suburban area of Fukuoka prefecture in Kyushu, to determine the relationship between cardiovascular risk factors and carotid atherosclerosis. We investigated conventional cardiovascular risk factors in 1078 I city residents (375 men, mean age 63.7 and 703 women, mean age 60.0) in 2000 and 2364 K town residents (676 men, mean age 57.1 and 1688 women, mean age 53.0) in 1999. Carotid atherosclerosis was assessed by mean intima-media thickness (IMT) by B-mode ultrasound. The mean IMT was significantly lower in the residents of I city than in those of K town (P<0.05). Total cholesterol (TC) and low-density-lipoprotein cholesterol (LDL-C) levels and smoking rate were also lower in I city than in K town. Body mass index (BMI) and triglyceride (TG) level were higher in I city than in K town. In I city, multiple regression analysis found independent relationships between carotid atherosclerosis and age, sex (male), hypertension, LDL cholesterol, high-density-lipoprotein cholesterol (HDL-C), and diabetes. The lower mean IMT is probably related to a lower lifetime burden of atherosclerotic risk factors, which may in turn be related to the longevity of Okinawa residents. BMI was not a cardiovascular risk factor, although LDL cholesterol was a common important risk factor.


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        • Cockerham W.C.
        • Hattori H.
        • Yamori Y.
        The social gradient in life expectancy: the contrary case of Okinawa in Japan.
        Social Sci. Med. 2000; 51: 115-122
        • Kimura Y.
        • Takishita S.
        • Muratani H.
        • Kinjo K.
        • Shinzato Y.
        • Muratani A.
        • et al.
        Demographic study of first-ever stroke and acute myocardial infarction in Okinawa, Japan.
        Intern. Med. 1998; 37: 736-745
        • Fukiyama K.
        • Kimura Y.
        • Wakugami K.
        • Muratani H.
        Incidence and long-term prognosis of initial stroke and acute myocardial infarction in Okinawa, Japan.
        Hypertens. Res. 2000; 23: 127-135
        • Salonen R.
        • Salonen J.T.
        Progression of carotid atherosclerosis and its determinants: a population-based ultrasonography study.
        Atherosclerosis. 1990; 81: 33-40
        • Heiss G.
        • Sharrett A.R.
        • Barnes R.
        • Chambless L.E.
        • Szklo M.
        • Alzola C.
        Carotid atherosclerosis measured by B-mode ultrasound in population: association with cardiovascular risk factor in ARIC study.
        Am. J. Epidemiol. 1991; 134: 250-256
        • Kawamori R.
        • Yamasaki Y.
        • Matsushima H.
        • Nishizawa H.
        • Nao K.
        • Hougaku H.
        • et al.
        Prevalence of carotid atherosclerosis in diabetic patients. Ultrasound high-resolution B-mode imaging on carotid arteries.
        Diabetes Care. 1992; 15: 1290-1294
        • Burke G.L.
        • Evans G.W.
        • Riley W.A.
        • Sharrett A.R.
        • Howard G.
        • Barnes R.W.
        • et al.
        Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) Study.
        Stroke. 1995; 26: 386-391
        • Allan P.L.
        • Mowbray P.I.
        • Lee A.J.
        • Fowkes F.G.
        Relationship between carotid intima-media thickness and symptomatic and asymptomatic peripheral arterial disease. The Edinburgh Artery Study.
        Stroke. 1997; 28: 348-353
        • Bots M.L.
        • Hofman A.
        • Grobbee D.E.
        Increased common carotid intima-media thickness. Adaptive response or a reflection of atherosclerosis? Findings from the Rotterdam Study.
        Stroke. 1997; 28: 2442-2447
        • Salonen J.T.
        • Salonen R.
        Ultrasonographically assessed carotid morphology and the risk of coronary heart disease.
        Arterioscler. Thromb. 1991; 11: 1245-1249
        • Bots M.L.
        • Hoes A.W.
        • Koudstaal P.J.
        • Hofman A.
        • Grobbee D.E.
        Common carotid intima-media thickness and risk of stroke and myocardial infarction: The Rotterdam Study.
        Circulation. 1997; 96: 1432-1437
        • Sawayama Y.
        • Shimizu C.
        • Maeda N.
        • Tatsukawa M.
        • Kinukawa N.
        • Koyanagi S.
        • et al.
        Effect of Probucol and Pravastatin on common carotid atherosclerosis in patients with asymptomatic hypercholesterolemia. Fukuoka Atherosclerosis Trial (FAST).
        JACC. 2002; 39: 610-616
        • Blankenhorn D.H.
        • Hodis H.N.
        George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.
        Arterioscler. Thromb. 1994; 14: 177-192
        • Hayashi J.
        • Kashiwagi S.
        • Nomura H.
        • Kajiyama W.
        • Ikematsu H.
        The control of hepatitis B virus infection with vaccine in Japanese nursery schools.
        Am. J. Epidemiol. 1987; 126: 474-479
        • Morofuji-Hirata M.
        • Kajiyama W.
        • Nakashima K.
        • Noguchi A.
        • Hayashi J.
        • Kashiwagi S.
        Prevalence of antibody to human T-cell lymphotropic virus type I in Okinawa, Japan, after an interval of 9 years.
        Am. J. Epidemiol. 1993; 137: 43-48
        • Maeda N.
        • Hayashi J.
        • Sawayama Y.
        • Tatsukawa M.
        • Simizu C.
        • Shigematsu M.
        • et al.
        Comparison of carotid atherosclerosis between the general population and hemodialysis patients.
        Atheroscler. Suppl. 2001; 2: 59-60
        • Hosaki S.
        • Kishimoto T.
        • Yamauchi M.
        • Shiina S.
        Serum lipoproteins in Japanese rural community with low cardiovascular mortality.
        Atherosclerosis. 1985; 54: 43-47
        • Mimura G.
        • Murakami K.
        • Gushiken M.
        Nutritional factors for longevity in Okinawa-present and future.
        Nutr. Health. 1992; 8: 159-163
      1. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva, Switzerland; 1997.

        • Hubert H.B.
        • Feinleib M.
        • McNamara P.M.
        • Castelli W.P.
        Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study.
        Circulation. 1983; 67: 968-977
        • Manson J.E.
        • Colditz G.A.
        • Stampfer M.J.
        • Willett W.C.
        • Rosner B.
        • Monson R.R.
        • et al.
        A prospective study of obesity and risk of coronary heart disease in women.
        New Engl. J. Med. 1990; 322: 882-889
        • Manson J.E.
        • Willett W.C.
        • Stampfer M.J.
        • Colditz G.A.
        • Hunter D.J.
        • Hankinson S.E.
        • et al.
        Body weight and mortality among women.
        New Engl. J. Med. 1995; 333: 677-685
        • Rexrode K.M.
        • Hennekens C.H.
        • Willett W.C.
        • Colditz G.A.
        • Stampfer M.J.
        • Rich-Edwards J.W.
        • et al.
        A prospective study of body mass index, weight change, and risk of stroke in women.
        J. Am. Med. Assoc. 1997; 277: 1539-1545
        • Burton B.T.
        • Foster W.R.
        • Hirsch J.
        • Vanltallie T.B.
        Health implications of obesity: NIH consensus development conference.
        Int. J. Obes. Relat. Metab. Disord. 1985; 9: 155-169
        • Must A.
        • Spadano J.
        • Coakley E.H.
        • Field A.E.
        • Colditz G.
        • Dietz W.H.
        The disease burden associated with overweight and obesity.
        J. Am. Med. Assoc. 1999; 282: 1523-1529
        • Losonczy K.G.
        • Harris T.B.
        • Cornoni-Huntley J.
        • Simonsick E.M.
        • Wallace R.B.
        • Cook N.R.
        • et al.
        Does weight loss from middle age to old age explain the inverse weight mortality relation in old age?.
        Am. J. Epidemiol. 1995; 141: 312-321
        • Ho S.C.
        • Woo J.
        • Sham A.
        Risk factor change in older persons, a perspective from Hong Kong: weight change and mortality.
        J. Gerotol. Med. Sci. 1994; 49: M269-M272
        • Andres R.
        • Muller D.C.
        • Sorkin J.D.
        Long-term effect of change in body weight on all-cause mortality.
        Ann. Intern. Med. 1993; 119: 737-743
        • Rexrode K.M.
        • Carey V.J.
        • Hennekens C.H.
        • Walters E.E.
        • Colditz G.A.
        • Stampfer M.J.
        • et al.
        Abdominal adiposity and coronary heart disease in women.
        J. Am. Med. Assoc. 1998; 280: 1843-1848
        • Lakka T.A.
        • Lakka H.M.
        • Salonen R.
        • Kaplan G.A.
        • Salonen J.T.
        Abdominal obesity is associated with accelerated progression of carotid atherosclerosis in men.
        Atherosclerosis. 2001; 154: 497-504
        • Rössner S.
        • Bo W.J.
        • Hiltbrandt E.
        • Hinson W.
        • Karstaedt N.
        • Santiago P.
        • et al.
        Adipose tissue determinations in cadavers: a comparison between crosssectional planimetry and computed tomography.
        Int. J. Obes. 1990; 14: 893-902
        • William M.J.
        • Hunter G.R.
        • Kekes-Szabo T.
        • Trueth M.S.
        • Synder S.
        • Berland L.
        • et al.
        Intra-abdominal adipose tissue cut-point related to elevated cardiovascular risk in women.
        Int. J. Obes. Relat. Metab. Disord. 1996; 20: 613-617
        • Suzuki R.
        • Watanabe S.
        • Hirai Y.
        • Akiyama K.
        • Nishide T.
        • Matsushima Y.
        • et al.
        Abdominal wall fat index, estimate by ultrasonography, for assessment of the ratio of visceral fat to subcutaneous fat in the abdomen.
        Am. J. Med. 1993; 95: 309-314
        • Ribeiro-Filho F.F.
        • Faria A.N.
        • Kohlmann O.
        • Ajzen S.
        • Ribeiro A.B.
        • Zanella M.T.
        • et al.
        Ultrasonography for evaluation of visceral fat and cardiovascular risk.
        Hypertension. 2001; 38: 713-717
        • Savage P.J.
        • Harlan H.R.
        Racial and ethnic diversity in obesity and other risk factors for cardiovascular disease: implications for studies and treatment.
        Ethn. Dis. 1991; 1: 200-211
        • Stevens J.
        • Plankey M.W.
        • Williamson D.F.
        • Thun M.J.
        • Rust P.F.
        • Palesch Y.
        • et al.
        The body mass index–mortality relationship in white and African American women.
        Obes. Res. 1998; 6: 268-277
        • Hingorani A.D.
        • Liang C.F.
        • Fatibene J.
        • Lyon A.
        • Monteith M.S.
        • Parsons A.
        • et al.
        A common variant of the endothelial nitric oxide synthase Glu298Asp is a major risk factor for coronary artery disease in the UK.
        Circulation. 1999; 100: 1515-1520
        • Slimane M.N.
        • Lastavel S.
        • Maatouk S.F.
        • Soutar A.K.
        • Farhat M.H.B.
        • Clavey V.
        • et al.
        Fh-Souassi: a founder frameshift mutation in exon 10 of the LDL-receptor gene, associated with a mild phenotype in Tunisian.
        Atherosclerosis. 2001; 154: 557-565
        • Mikkelsson J.
        • Perola M.
        • Penttilä A.
        • Goldschmidt-Clermont P.J.
        • Karhunen P.J.
        The GPIIIa (beta integrin) PlA polymorphism in the early development of coronary atherosclerosis.
        Atherosclerosis. 2001; 154: 721-727
        • Marenberg M.E.
        • Risch N.
        • Berkman L.F.
        • Floderus B.
        • de Faire U.
        Genetic susceptibility to death from coronary heart disease in a study of twins.
        New Engl. J. Med. 1994; 330: 1041-1046