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REVIEW ARTICLE
Received: 21 April 2011 / Accepted: 20 June 2011 / Published online: 9 July 2011
# European Association for Predictive, Preventive and Personalised Medicine 2011
At Risk for HF
STAGE A
At high risk for HF but
without structural heart
disease or symptoms
of HF
STAGE B
Structural heart
disease but without
signs or symptoms of
HF
hypertension
atherosclerotic disease
diabetes
obesity
metabolic syndrome
previous MI
LV remodeling including
LVH and low EF
asymptomatic valvular
disease
Overt HF
STAGE C
Structural heart disease
with prior or current
symptoms of HF
STAGE D
Refractory HF
requiring specialized
interventions
e.g., Patients
427
2009
1950
Male
Male
Female
Female
100
9599
9094
8589
8084
7579
7074
6569
6064
5559
5054
4549
4044
3539
3034
2529
2024
1519
1014
59
04
100
9599
9094
8589
8084
7579
7074
6569
6064
5559
5054
4549
4044
3539
3034
2529
2024
1519
1014
59
04
Multiple dietary factors are strongly associated with atherosclerotic disease (including CAD) and appropriate diet
modification can have beneficial effects. A common feature
of the diets that help to prevent CAD is the emphasis on plant-
40
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2010
2020
2030
2040
2050
30
20
10
Japan
China
U.S.
U.K.
Sweden
Men
50
Women
50
40
30
20
10
0
40
30
20
10
0
1987
1993
1998
2003
2008
1987
1993
1998
2003
2008
Men
90
80
70
60
50
40
30
20
10
0
90
80
Women
Years
70
60
50
40
15-19
20-29
30-39
40-49
30
50-59
20
60-69
10
70
50
40
30
20
10
Men
50
40
Women
Years
20-29
30
30-39
40-49
50-59
20
60-69
70
10
Men
Percentage of women with BMI 25 (%)
50
40
30
20
10
0
50
Women
40
Years
20-29
30
30-39
40-49
20
50-59
60-69
10
70
Fig. 7 Trend of percentage of individuals with BMI 25 kg/m2 by age [18]. BMI, body mass index
220
210
200
190
180
170
Men
230
230
Women
220
Years
210
20-29
30-39
200
40-49
50-59
190
60-69
70
180
170
431
Age-adjusted Mortality
Crude Mortality
Rate/100,000
Rate/100,000
180
160
160
140
140
120
120
100
AMI, Men
100
AMI, Women
80
80
60
60
40
40
20
20
0
Year
Year
Fig. 9 Trend of mortality rate by various heart diseases [7]. AMI, acute myocardial infarction; CAD, coronary artery disease
90,000
Men
Women
90,000
80,000
80,000
70,000
70,000
60,000
60,000
50,000
50,000
40,000
40,000
30,000
30,000
20,000
20,000
10,000
10,000
Years
30-49
50-64
65-74
75
Year
Year
Fig. 10 Trend of number of individuals who died from heart diseases by age [7]
300,000
250,000
200,000
150,000
100,000
50,000
0
Year
Fig. 11 Number of ambulance service in the Tokyo Fire Department [45]
433
CHART-2 study
The prevalence and crude mortality rate of CVD has been
relatively lower in Japan compared with that in Western
countries. However, it has been rapidly increasing due to
the westernization of lifestyle, increased risk of atherosclerosis, and a rapidly aging population [7, 9]. Our previous
cohort study of HF patients, the CHART-1 Study, revealed
that the most prevalent etiology of HF in Japan was nonischemic cardiomyopathy (28.6%) and only 25.4% of HF
was attributed to CAD (which is the leading cause of HF in
most Western countries) [8]. We started a multicenter
prospective cohort study, the CHART-2 Study, in October
2006 to evaluate the clinical characteristics and prognosis
of Japanese patients at high risk for disease progression of
CVD or those with overt HF [14]. The study was conducted
in collaboration with 24 hospitals in the Tohoku district;
this is in the north-east of Japan and has a population of 9.8
million. Stable patients aged 20 years were consecutively
enrolled in the study who were suffering from CAD or were
in stage B, C, or D as defined by the Guidelines for the
Diagnosis and Management of HF in Adults of the ACC
Foundation/AHA [10]. The entry period of the CHART-2
Study was closed in March 2010 (N=10219), which made
this study the largest-scale cohort of CVD in Japan [64].
LVDd
40
20
BNP
100
1200
1000
80
800
60
40
20
BNP (pg/mL)
60
LVEF
80
End-diastolic dimension (mm)*
600
400
200
0
*P<0.001
P<0.001
GFR
120
18
NS
Hemoglobin
UACR
800
16
100
80
60
40
14
600
UACR (mg/gCre)*
12
10
8
6
400
200
20
2
0
100
Fig. 14 Etiology of HF in
Western patients and CHART
patients [14]. Framingham, reference [65]; ADHERE, reference [66]; EHFS II, reference
[67]; Owan, reference [68];
Bhatia, reference [69]; CHART1, reference [8]; CHART-2,
reference [14]
P<0.01
*P<0.001
100
Hypertensive
100
80
80
80
60
60
60
40
40
40
20
20
20
Valvular
Hypertension
435
100
100
Diabetes Mellitus
80
60
40
ADHERE (N=105,388)
80
60
40
20
20
50
40
30
20
10
0
100
60
EHFS II (N=3,580)
CHART-1 (C/D, N=1,078)
CHART-2 (C/D, N=4,735)
60
40
20
70
80
HFpEF
80
40
20
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Conflict of interest None.
17.
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