Daily News 1 24

1
Daily News

• May 31 (Thursday)

-- Topics of the presentations of yesterday --
ICPC
IHHC
2
PL-V-1 Plenary Session Rose Stamler Memorial
LecturePolicy-making for CVD PreventionDR
Labarthe, USA

• To prevent cardiovascular disease, it
  is important to prevent cardiovascular risk
  factors. Especially high blood pressure is still
  the most important burden all over the world. The
  Healthy People 2010 shows the goal of
  hypertension to reduce the prevalence 16. Blood
  pressure can be controlled through changes of
  life-style, such as weight loss, alcohol
  consumption reduction, and exercise. However, it
  is not easy to change life-style for each
  individual. To control risk factors, "logic
  model" is useful. First, it is necessary to
  change unfavorable social and environmental
  conditions second, to change adverse behavior
  pattern third, to manage risk factors fourth,
  to prevent first event. Scientific results,
  policy-making, and individual behavior changes
  should work interactively. Science has roles of
  evaluation for risks, burden, prevalence, and
  intervention. Policy has roles of clarification
  of objectives and strategies. Actions should be
  taken leaning lessons of the past.

3
Memorial Lecture
4
PL-V-2 Plenary SessionPrevention of Stroke New
InsightControl of risk factors and primary
prevention of strokePhillip A Wolf, MD

• Identification of the major precursors
  of stroke is the first step in disease
  prevention. Indicators which are amenable to
  modification include hypertension cigarette
  smoking low levels of physical activity
  elevated homocysteine levels atrial fibrillation
  (AF) and, symptomatic significant extracranial
  carotid stenosis. Persons with prior stroke or
  transient ischemic attack are at particularly
  high risk. Common cardiac diseases predispose to
  stroke including coronary heart disease (CHD) or
  acute MI, congestive heart failure and, atrial
  fibrillation. Observational data support
  cessation of smoking and promotion of moderate
  physical activity as a means of stroke reduction.
  Controlled clinical trials show that controlling
  blood pressure reduces stroke incidence. Warfarin
  anticoagulation prevents stroke in AF. Aspirin
  and other antiplatelet agents reduce stroke
  recurrence. Elaveted plasma homocysteine levels
  have been implicated in stroke risk and
  prevention. Identification of risks of stroke
  will facilitate prevention. The degree of risk of
  stroke can be provided by a stroke risk profile
  which accounts for the impact of each risk factor
  and for the cumulative increased risk of
  borderline levels of multiple risk factors.

5
PL-VI-2 Plenary Session Geoffrey Rose Memorial
LecturePopulation strategy for Tobacco Control
in Developed and Developing CountriesR Peto, Y
Saloojee, LA Hanafiah, and JM Mackay

• In this symposium, speakers emphasize
  the population strategies for tobacco control in
  developed and developing countries in order to
  reduce the increased annual death from tobacco
  use.
• Tobacco industries are breaking its
  records year after year in regards with profits
  and volume of sales, and 4 million people are
  killed by tobacco every year. A quarter of total
  smokers are in middle age (35-69 years) when they
  die. Smoking in younger age shortens their
  lives, so it is very important to prevent youth
  from smoking. Because tobacco industries lose
  product liability litigation in developed
  countries like the United States, the industries
  expand its markets in developing countries with
  fewer regulations so as to maintain their
  profits. If the current patterns continue, by
  2030, tobacco will kill 10 million people of
  which 70 come from developing countries. There
  is a pressing need to mobilize organisations,
  such as NGOs and WHO, to do better-coordinated
  activities through the establishment of national
  movements for tobacco control. This would set
  the stage for better advocacy for decision makers
  and the people.

6
Registration Desk
7
S-20 SymposiumIn Secondary Prevention of
StrokeEffects of Antiplatelet Therapy for the
Secondary Prevention of StrokeC Baigent, UK

• The Antithrombotic Trialist'
  Collaboration (ATT) with over 40,000 cases in
  1997 shows significant 22 reduction of serious
  vascular events for the secondary prevention of
  stroke (Aspirin 160-300 mg/day 10.7 vs control
  13.1). Aspirin produced absolute excess of 2
  (SE 1) haemorrhagic strokes, but did absolute
  reduction of 7 (SE 2) ischaemic strokes at the
  same time. This produced overall effectiveness
  of all stroke reduction. In conclusion, the
  speaker recommends that Aspirin 75-150mg/day for
  2 years for the secondary prevention of stroke
  since the treatment brings a 32 reduction of
  secondary stroke. In case of Aspirin
  contraindication, the speaker suggests that
  clopidogrel, similar to ticlopidine, may be an
  alternative therapy.

8
S-21 SymposiumPrevention of the Risk Factors
Themselves in Childhood and BeyondChairpersons
DR Labarthe, S BabaT Ohta, GS Berenson, LJ
Kolbe, E Vartiainen

• Ohta presented Dyslipidemia in young
  Japanese children lessons from mass screening
  for familial hypercholesterolemia using data of
  18 month old children screening apoB project in
  Kumamoto. He concluded that a fairly amount of
  dyslipidemia found in young children were
  familial. Setting appropriate eating patterns
  during childhood might be important to normalize
  factors for atherosclerotic coronary heart
  disease even in Japanese children.
• Berenson reported Bogalusa Heart
  Study. Long-term observations provide an
  opportunity to study tracking and to determine
  whether levels of risk factor variables in child
  tend to remain in a given rank relative to their
  peers. Observations of cardiovascular risk
  factors beginning in childhood, and the
  associations with anatomic changes justify
  screening the general population of children and
  beginning prevention in early life.
• LJ Kolbe presented 'National
  strategies to monitor and reduce cardiovascular
  disease risk factors among young people in the
  United States. Many kinds of strategies were
  shown.
• Varitiainen presented North Karelia
  Youth Study. From the first North Karelia Youth
  Project, school and community based smoking
  prevention program seems to have long term
  preventive effect on smoking. From the second
  youth project, major improvement in diet and
  reduction in serum cholesterol and blood pressure
  level were observed. Increases in obesity at
  teenage becoming more an important public health
  problem.

9
S-22 SymposiumG8 Promoting Heart Health
Telematics ProjectE Nussel, D.Cianflone, GC
Hogelin, and B Archer

• Dr. Nussel reported the information
  technology for medicine. One of these
  technologies is patient's monitoring system. The
  first step of this system is "Feelgood". Peoples
  with heart disease wear sensory devices which can
  record biological parameters and signalize health
  danger. The second step is "Beacon" which
  monitors patient's precise position and informs
  the medical team of the position. The third step
  is "Global Positioning System." Medical team with
  light equipment can be guided directly to the
  patient. The forth step is "Global System for
  Mobile Communications" which gives patient's
  vital signs and all history of disease to
  emergency center. The second to forth steps are
  now available.

10
S-23 SymposiumDiabetes mellitus and CVDB
Balkau, N Chaturvedi, K Pyorala, and J
Tuomilehoto

• The spectrum of cardiovascular complications of
  type ?diabetes
• Anti-hypertensive therapy and CVD prevention in
  diabetes
• Hypolipidemic treatment for cardiovascular
  prevention in diabetes
• Hyperglycaemia and the prevention of
  cardiovascular risk

11
S-24 SymposiumGender Difference in CVDThe
Women's Health Initiative A Clinical Trial to
Determine the Impact of HRT, a Low Fat/High Fiber
Diet and Calcium/Vitamin D Supplementation of the
Overrall Health of Postmenopausal Women B
Rodriguez

• The National Heart, Lung, and Blood
  Institute has launched a large clinical trial and
  observational study to examine the effects of
  hormone replacement therapy(HRT), a low fat/high
  fiber diet, and calcium/vitamin D supplementation
  on the overall health of postmenopausal women.
  HRT is expected to reduce the incidence of CVD
  and fractures, a low fat/high fiber diet is
  expected to benefit breast cancer and colorectal
  cancer. Details of the study is followed.
  166,500 women aged 50-79 years was recruited
  within 3-4 yr. Randamization to CT or Enrollment
  to OS was done. 27,348 women enrolled in the HRT
  including 50 of placebo, 48,837 in the dietary
  component and 36,275 in the calcium/vitamin D.
  overlapped was 11.8. The average follow-up
  period is 8.5 years. Goals of the study total
  fat is 20 of calories, saturated fat is 7 of
  calories, vegerables. fruits are 5 servings/day,
  maintaining of the diet for 9 years. Final
  result of the WHI study will be available in 2005.

12
S-25 SymposiumPrevention of Rheumatic
FeverKMHS Sirajul Haque, P Nordet

• In this session Haque presented a paper
  on the epidemiology and prevention of rheumatic
  fever in Bangladesh. Rheumatic fever and
  rheumatic heart disease is prevalent in
  Bangladesh as it is in any other developing
  countries in the world. Although the causative
  agent and the patho-physiology is known for
  years, there have been lack of appropriate
  policies for primary prevention of rheumatic
  fever. In Bangladesh, 4-12 / 1000 school children
  have acute rheumatic fever. In Bangladesh
  National Center for Control of Rheumatic Fever
  and Heart Disease was established by Bangladesh
  government with the help of Japanese Government
  and this center is serving a wide group of
  patients and also doing researches of rheumatic
  fever in Bangladesh.
• Noredt from WHO informed the audience
  that WHO is taking steps to put rheumatic fever
  in their priority list and also an update of
  guidelines and policy for control of rheumatic
  fever will be ready by next year. Nordet also
  informed the audience that there are about 400000
  deaths annually from rheumatic fever or rheumatic
  heart disease and since poorer section of the
  poor countries suffer from this disease,
  governments should be advocated to take policy
  for prevention of these diseases.

13
S-26 SymposiumARB therapy for Cardiovascular
DiseaseGordon T McInnes

• Selective angiotensin (ATI) receptor
  blockade has enormous potential in cardiovascular
  medicine. Angiotensin receptor blocker (ARB)
  therapy provides effective blood pressure control
  equivalent to that with calcium channel blockers,
  ACE inhibitor and the other major
  antihypertensive drug classes.
• Early findings in patients with heart
  failure were equivocal. However, much more works
  are underway and any conclusions are premature.
  In next few years, we should see the accumulation
  of a large body of evidence on the role of ARB
  therapy, particularly with Valsartan, in
  cardiovascular disease. These findings will have
  immense importance in determining the role of
  angiotensin receptor blockade.

14
S-27 SymposiumEUROASPIRE II (European Action on
Secondary and Primary Prevention by Intervention
to Reduce Events)K Pyorala, DA Wood, D de
Bacquer, G de Backer

• To update the information on the
  practice of secondary prevention of CHD in Europe
  derived in EUROASPIRE I and to see whether there
  had been an improvement since the first survey,
  EUROASPIRE II was carried out in 15 European
  countries in 1999/2000. Prevalence of smoking and
  prevalence of obesity have increased. Prevalence
  of hypertension and prevalence of
  hypercholesterolemia have decreased, however the
  majority of coronary patients are still not
  achieving the BP and cholesterol goals, despite
  the increased use of prophylactic drug therapies
  and in particular statins. Results from the
  family screening survey indicate significant
  clustering of coronary risk factors in siblings
  and offspring of patients with premature CHD.
  Keeping monitoring and dedicating evidence-based
  medicine are important.

15
S-28 SymposiumGlobal Youth Tobacco Surveillance

• The Global Youth Tobacco Surveillance
  (GYTS) is technically assisted by WHO and CDC,
  and is intended to enhance the capacity of
  countries to design, implement, and evaluate
  comprehensive tobacco control programs. It
  gathers data from youth aged 13-15 using a
  school-based survey. It comprises 54 questions
  covering 7 topics prevalence, knowledge and
  attitudes, media and advertising, access and
  availability, school curriculum, environmental
  tobacco smoke exposure, and cessation. Now about
  half members of WHO are participating in the
  program.
• In this session GYTS was briefly
  introduced and results obtained in Latin America,
  India and Eastern Europe were reported.

16
Commercial Exhibits
17
L-08 Special LectureSeven mysterious
characteristics of stroke in JapanResults from
the Akita registerKazuo Suzuki

• Stroke is not only one of the leading
  causes of death but also a major cause of
  disability in Japan. This paper shows the results
  of a stroke register set up in Akita to further
  understand stroke in Japan. The target population
  of the register is 1.2 million. Stroke diagnosis
  is determined using the WHO MONICA stroke
  criteria and CT or MRI is used to diagnose stroke
  subtypes. The register started in 1984, and to
  date 42881 cases have been registered. Seven
  mysterious characteristics are as following
  1)higher incidence of cerebral haemorrhage (CH)
  than Western countries 2) Subarachnoid
  haemorrhage in men plateaus at 60 years of age
  and then decreases 3) The location of ruptured
  aneurysms varies depending on sex. 4) Seasonal
  variations in incidence were observed for
  haemorrhagic stroke (HS) but not for ischemic
  stroke. 5) Diurnal differences with peaks at 7 am
  and at 5 pm were observed in HS. 6) Patients with
  CH in the thalamus were older than those in the
  putamen. 7) Half of all stroke cases consisted of
  patients on medication for hypertension.

18
F-28 132Beneficial Effects of Physical Fitness
on the Incidence of Hypertension in a Japanese
CohortHideo Sasaki, Jiro Oiwa, and Chikako Ito,
Hiroshima, JAPAN

• This session was to evaluate the
  beneficial effects of physical fitness on the
  hypertension incidence. 2,961 normotensives were
  conducted at initial exam of Hiroshima Health
  Promotion Center. The average follow-up was 3.5
  years. Two-hundred and ninety-one incident were
  hypertensives and 2,670 were normotensives at
  follow-up exam. The impact of physical fitness
  and other covariates were investigated with Coxs
  proportional hazard model. The incidence of
  hypertension elevated in accordance with age, BMI
  and alcohol intake at any age group.
  Cardiovascular fitness was inversely related with
  hypertension incidence in the group younger than
  60 years of age. Relative risk of higher
  cardiovascular for hypertension was significantly
  low in men (RR 0.72), in higher LTPA group (RR
  0.73), and higher alcohol intake group (RR 0.63).

19
Concert Evening (In corporation with Takarazuka
Review Company)
20
Concert Evening (In corporation with Yabukarabo
Japanese Drum Club)
21
Sightseeing Osaka -- Universal Studios Japan

• Thrilling and Exciting! Experience the
  essence of entertainment
• With the world of Hollywood as its
  theme, Universal Studios Japan is where the
  movies come alive, drawing all the guests into
  the exhilaration and excitement, the power of an
  authentic. Hollywood experience. The Power of
  Hollywood! Only at Universal Studios Japan.
• JR-West offers convenient through train
  and shuttle. Through Train (Tennoji - Kyobashi -
  Osaka - Nishikujo - Universal-city - Sakurajima)
  and Shuttle (Nishikujo - Universal-city -
  Sakurajima).

22
Message from participants

• Kalevi Pyorale
• This has been an important scientific
  conference in which new developments in
  prevention of cardiovascular disease have been
  presented. It has given opportunity for
  scientists from all parts of the world to meet
  each other and exchange experiences. The
  hospitality of Japanese staffs has been
  overwhelming.
• Lars Wilhelmsen
• Many good presentations. However, too
  many parallel sessions. Accordingly, too limited
  attendance at each session, and I missed many
  sessions myself.

23

• Darwin Labarthe
• The conference has successfully brought together
  fellow scientists, colleagues, and friends from
  many countries. Exchanging information and
  renewing contacts has been a valuable
  contribution of the conference. A very special
  feature was the reunion of graduates from the
  international and national seminars. Many thanks!
• David Goff
• Hypertension prevention and control is
  a major challenge on a global basis. Dr. Dong
  Zhao's work on high blood pressure in China
  underscores the need for prevention to advance in
  concert with programs to control blood pressure
  among 100,000,000 Chinese with hypertension. Dr.
  Darwin Labarthe's comments regarding policy and
  programmatic development related to the
  prevention of high blood pressure point as in a
  positive direction. Promotion of efforts to
  prevent the development of high blood pressure
  could be an enduring outcome of this excellent
  conference.

24
Acknowledgement

• The Publication Committee thanks all
  the contributors for the Daily News Choudhury SR
  (Helen Keller International), Gotoh T (Jichi
  Medical School), Isihikawa S (Jichi Medical
  School), Kagamimori S (Toyama Medical and
  Pharmacological University), Kayaba K (Jichi
  Medical School), Kishimoto T (Tottori
  University), Miura K (Kanazawa Medical School),
  Morioka S (Wakayama Medical College), Muta H
  (Kurume University), Nakamura M (Hamamatsu
  Medical School), Nakamura Y (Shiga University of
  Medical Science), Nishi N (Takarazuka City), Noso
  M (Hiroshima University), Oguri S (Iwate Medical
  University), Okayama A (Iwate Medical
  University), Okuda N (Shiga University of Medical
  Science), Osuga K (Jichi Medical School), Saito S
  (Sapporo Medical University), Sakai K (Jichi
  Medical School), Sakata K (Wakayama Medical
  College), Sato T (Kitasato University), Segawa I
  (Iwate Medical University), Tamaki J (Wakayama
  Medical College), Tanihara S (Shimane Medical
  School), Tsutsumi A (Kurume University), Ueshima
  K (Iwate Medical University), Watanabe M (Shiga
  University of Medical Science), Yamada S (Jichi
  Medical School), Yokoyama T (Tokyo Medical and
  Dental University), Yoshida Y (Fukui Medical
  School), Yoshimura N (Wakayama Medical College).
• (Alphabetically in order)

Publication Committee Yanagawa H (chair),
Nakamura Y (vice-chair), Ojima T, Oki I, Tajimi M.