Daily News May 31 (Thursday) PL-V-1 Plenary Session Rose Stamler Memorial Lecture Policy-making for CVD Prevention DR 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. PL-V-2 Plenary Session Prevention of Stroke: New Insight Control of risk factors and primary prevention of stroke Phillip 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. PL-VI-2 Plenary Session Geoffrey Rose Memorial Lecture Population strategy for Tobacco Control in Developed and Developing Countries R 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. S-20 Symposium In Secondary Prevention of Stroke Effects of Antiplatelet Therapy for the Secondary Prevention of Stroke C 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. S-21 Symposium Prevention of the Risk Factors Themselves in Childhood and Beyond Chairpersons: DR Labarthe, S Baba T Ohta, GS Berenson, LJ Kolbe, E Vartiainen Ohta presented gDyslipidemia in young Japanese children: lessons from mass screening for familial hypercholesterolemiah 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.f 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. S-22 Symposium G8 Promoting Heart Health Telematics Project E 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. S-23 Symposium Diabetes mellitus and CVD B Balkau, N Chaturvedi, K Pyorala, and J Tuomilehoto The spectrum of cardiovascular complications of type ‡Udiabetes Anti-hypertensive therapy and CVD prevention in diabetes Hypolipidemic treatment for cardiovascular prevention in diabetes Hyperglycaemia and the prevention of cardiovascular risk S-24 Symposium Gender Difference in CVD The 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. S-25 Symposium Prevention of Rheumatic Fever KMHS 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. S-26 Symposium ARB therapy for Cardiovascular Disease Gordon 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. S-27 Symposium EUROASPIRE 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. S-28 Symposium Global 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. L-08 Special Lecture Seven mysterious characteristics of stroke in Japan Results from the Akita register Kazuo 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. F-28 132 Beneficial Effects of Physical Fitness on the Incidence of Hypertension in a Japanese Cohort Hideo 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 Coxfs 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). 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). 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. 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. 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.