JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease
Akira Fujiyoshi, Shun Kohsaka, Jun Hata, Mitsuhiko Hara, Hisashi Kai, Daisaku Masuda, Naomi Miyamatsu, Yoshihiko Nishio, Masatsune Ogura, Masataka Sata, Kenji Sekiguchi, Yasushi Takeya, Kouichi Tamura, Akihiko Wakatsuki, Hiroshi Yoshida, Yoshio Fujioka, Ryuji Fukazawa, Osamu Hamada, Aya Higashiyama, Mai Kabayama, Koshiro Kanaoka, Kenjiro Kawaguchi, Shintaro Kosaka, Ayako Kunimura, Ayumi Miyazaki, Masaki Nii, Mitsuaki Sawano, Masakazu Terauchi, Shusuke Yagi, Takashi Akasaka, Tohru Minamino, Katsuyuki Miura, Koichi Node, on behalf of the Japanese Circulation Society Joint Working Group
Abstract
Coronary artery disease (CAD) remains a significant health problem in Japan, requiring improved primary prevention measures.The Japanese Circulation Society (JCS) and other professional societies have been actively involved in addressing this need by publishing clinical practice guidelines to provide up-to-date recommendations for healthcare professionals.The initial version of the primary prevention guideline entitled "Guidelines for the Primary Prevention of Ischemic Heart Disease (in Japanese)" was published in 2001.Since then, the guideline has been updated periodically.The 2023 edition entitled "Guideline on the Primary Prevention of Coronary Artery Disease" holds particular significance as it represents a notable milestone -being the inaugural primary prevention guideline from the JCS to be translated into English.For the 2023 revision, a Joint Working Group was formed, consisting of the JCS and 10 other academic societies, and the members of the Writing Committee were recruited from each society comprising the Joint Working Group (the list of academic societies of the Joint Working Group is provided on the front page).In addition to incorporating new scientific evidence, the Writing Committee put particular effort into the following points in this revision.First, we minimized descriptions of background information that is already widely known and focused more on providing clinically relevant ABI ankle-brachial index ABPM ambulatory blood pressure monitoring ACC American College of Cardiology ACE angiotensin-converting enzyme ACS acute coronary syndrome ADL activities of daily living AHA American Heart Association AKI acute kidney injury AMI acute myocardial infarction ARB angiotensin II receptor blocker ARH autosomal recessive hypercholesterolemia ASCVD atherosclerotic cardiovascular disease baPWV brachial-ankle pulse wave velocity BMI body mass index CAD coronary artery disease CAVI cardio-ankle vascular index CCA common carotid artery CKD chronic kidney disease CKD-EPI Chronic Kidney Disease Epidemiology Collaboration COPD chronic obstructive pulmonary (lung) disease CRP C-reactive protein CVD cardiovascular disease CVO cardiovascular outcome DASC-8 Epidemiological Reports on Temporal Trends in CAD Incidence The Akita-Osaka Study 6 is a long-term study conducted from 1964 to 2003 involving local residents, aged 40-69 years, from one urban area (Yao City, Osaka Prefecture) and one rural area (Ikawa Town, Akita Prefecture) in Japan.Among urban men, the age-adjusted incidence rate of CAD (myocardial infarction [MI], coronary artery intervention, and sudden cardiac death) increased significantly after 1980, mainly due to an increased number of individuals treated by coronary artery intervention.However, no clear change was observed among urban women and rural men.Of note, the number of cases of CAD was extremely low among rural women from Ikawa Town. In the Hisayama Study, 7 the incidence rate of CAD and AMI from 1961 to 2009 was examined in residents aged 40 years from Hisayama Town, Fukuoka Prefecture, which is a suburban area near Fukuoka City.No apparent change was observed in the age-adjusted CAD incidence rate or age-adjusted AMI incidence rate among men between 1961 and 2009. However, among women, there was a significant decline in the CAD incidence rate after the 1980s, with a similar pattern observed for the AMI incidence rate, although the change was not significant.Age-group stratification revealed that the AMI incidence rate increased among individuals in their 80s from the 1960s to the 1980s and remained unchanged thereafter.The Akita-Osaka Study and the Hisayama Study were 2 representative studies examining long-term changes in CAD incidence rates dating from the 1960s to the 2000s.However, due to their small population sizes, the statistical power to evaluate temporal changes in CAD incidence rates was limited.Accordingly, recent observational studies conducted after the 1980s have recruited a larger sample of the population to overcome this limitation. An epidemiological study conducted in Takashima City, Shiga Prefecture, 8 reported that the age-adjusted AMI incidence rate increased in both sexes during 1990 and 2001.Age-group stratification revealed that the increase was significant among individuals aged 65 and a non-Mediterranean 0