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PurposeSome but not all randomized controlled trials (RCTs) of soy isoflavones showed their beneficial effect on arterial stiffness, a predictor of cardiovascular events, dementia, and all-cause mortality, independent of traditional risk factors. To test the hypothesis that supplementation of soy isoflavones reduces arterial stiffness, we performed a systematic review and meta-analysis of RCTs of soy isoflavones on arterial stiffness.MethodsThe protocol of this systematic review was registered with PROSPERO (CRD42019126128) and written in accordance with PRISMA. The PubMed, Embase, and clinicaltrials.gov databases were searched using the following criteria: human subjects, soy isoflavones as intervention, and arterial stiffness as primary outcome. A random-effects meta-analysis was used to pool estimates across studies. Standardized mean difference (SMD) was used to synthesize quantitative results.ResultsAmong 998 articles retrieved, 8 articles met our criteria. Duration of intervention was relatively short (maximum of 12 weeks). Outcome measurements extracted were pulse wave velocity (PWV), systemic arterial compliance (SAC), augmentation index (AI), and cardio-ankle vascular index (CAVI). Soy isoflavones reduced arterial stiffness compared to placebo (standardized mean difference − 0.33, 95% confidence interval − 0.47, − 0.19). Subgroup analyses showed no difference between treatment effects for intervention duration (< 6 weeks vs. ≥ 6 weeks) or gender (women only vs. men only vs. combined). Sensitivity analysis showed no difference in the effect of soy isoflavones between PWV, CAVI, SAC, and AI.ConclusionSupplementation of soy isoflavones reduced arterial stiffness. Longer duration trials with larger number of participants are warranted.

Background: A recent systematic review showed Japan’s mortality from chronic obstructive pulmonary disease (COPD) is the lowest among 204 countries, despite notably higher smoking rates in men in Japan than in the United States. This study aims to compare (1) trends in smoking rates, (2) trends in COPD mortality, and (3) the spirometry-based COPD prevalence in the general adult population between Japan and the United States.Methods: Age- and sex-specific smoking rates from the 1980s through 2010s and COPD mortality from 1999 through 2019 were obtained from national surveys and official statistics (International Classification of Diseases-10th codes J40–44), respectively. A systematic review and meta-analysis was performed to estimate COPD prevalence in Japan, while the National Health and Nutrition Examination Survey 2007–2012 was used for the United States. A fixed ratio of 0.7 of forced expiratory volume in the first second of forced vital capacity was used to define COPD.Results: Over the past 4 decades, men in Japan consistently had 20–30% higher smoking rates than their United States counterparts. From 1999–2019, age-adjusted COPD mortality in men in Japan was only a third of the United States, whereas that in women was less than a tenth in 2019. Synthesizing data from 11 studies, involving 89,955 participants, Japan’s COPD prevalence was more than 10% lower than in the United States in almost all age groups for both sexes.Conclusion: This study showed markedly lower rates of COPD in Japan than in the United States. Investigating factors contributing to the paradoxical observations could lead to advancing COPD risk reduction strategies.

Equol, a soy isoflavone-derived metabolite of the gut microbiome, may be the key cardioprotective component of soy isoflavones. Systematic reviews have reported that soy isoflavones have no to very small effects on traditional cardiovascular disease risk factors. However, the potential mechanistic mode of action of equol on non-traditional cardiovascular risk factors has not been systematically reviewed. We searched the PubMed through to July 2021 by using terms for equol and each of the following markers: inflammation, oxidation, endothelial function, vasodilation, atherosclerosis, arterial stiffness, and coronary heart disease. Of the 231 records identified, 69 articles met the inclusion criteria and were summarized. Our review suggests that equol is more lipophilic, bioavailable, and generally more potent compared to soy isoflavones. Cell culture, animal, and human studies show that equol possesses antioxidative, anti-inflammatory, and vasodilatory properties and improves arterial stiffness and atherosclerosis. Many of these actions are mediated through the estrogen receptor β. Overall, equol may have a greater cardioprotective benefit than soy isoflavones. Clinical studies of equol are warranted because equol is available as a dietary supplement.

Equol is an isoflavone (ISF)-derived metabolite by the gut microbiome in certain individuals termed equol-producers (EP). Equol might be the critical anti-atherogenic component of ISFs. In a population-based study of 979 Japanese men aged 40–79 without cardiovascular (CVD) or chronic kidney disease, we measured the urinary levels of equol and ISFs. Aortic calcification (AC) in the entire aorta was assessed by electron-beam or multi-detector-row computed tomography. Subjects with log10 (urinary equol to daidzein concentration) > − 1.5 were classified as EP. EP was further classified as person with low- and high-equol. We analyzed the association between equol-producing status and AC presence, defined as AC score > 0, by the logistic regressions. We found that EP (50% of the sample) had significantly lower odds of AC presence (odds ratio (OR): 0.62, 95% confidence interval (CI): 0.39, 0.98) compared to non-EP. This association was independent of CVD risk factors. For the dose–response association, compared to non-EP, subjects with low and high levels of equol had ORs of 0.51 (95% CI 0.30, 0.84) and 0.67 (95% CI 0.39, 1.14) after adjusting for major CVD risk factors ( p for trend = 0.06). ISFs concentrations were not significantly associated with AC presence (OR: 1.18, 95% CI: 0.82, 1.69). In conclusion, EP had a significantly lower burden of AC than non-EP, while ISFs were not associated with AC presence in Japanese men aged 40–79 years.

Pancreatic cancer is one of the most deadly types of cancer for both genders. Classified as a human carcinogen, cadmium has been related to diverse cancers. However, the association between cadmium exposure and the risk of pancreatic cancer is still unclear. We quantitatively reviewed the observational studies on the association of cadmium exposure with pancreatic cancer risk among individuals without occupational exposure history published through July 2014 in PubMed by using a fixed-effect model. Four prospective cohort studies (112,934 participants with 335 events) and two case–control studies (177 cases and 539 controls) were identified. The summarized relative risk (RR) with a 95 % confidence interval (CI) was 2.05 (95 % CI = 1.58–2.66), comparing the highest to the lowest category of cadmium exposure. This positive association persisted in men (RR = 1.78, 95 % CI = 1.04–3.05) but not in women (RR = 1.02, 95 % CI = 0.63–1.65). Further research is needed to provide more solid evidence on the association of cadmium exposure with pancreatic cancer risk and to elucidate the underlying biological mechanism of the potential gender difference.

A recent randomized controlled trial (RCT), the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT), reported that high-dose marine omega-3 fatty acids (OM3) significantly reduce cardiovascular disease (CVD) outcomes, yet the mechanisms responsible for this benefit remain unknown. To test the hypothesis that high-dose OM3 is anti-atherosclerotic, we performed a systematic review and meta-analysis of RCT of high-dose OM3 on atherosclerosis. The protocol of this systematic review was registered with PROSPERO (CRD42019125566). PubMed, Embase, Cochran Central Register for Controlled Trials, and Clinicaltrials.gov databases were searched using the following criteria: adult participants, high-dose OM3 (defined as ≥3.0 g/day, or in Japan 1.8 g/day and purity ≥90%) as the intervention, changes in atherosclerosis as the outcome, and RCTs with an intervention duration of ≥6 months. A random-effects meta-analysis was used to pool estimates across studies. Among the 598 articles retrieved, six articles met our criteria. Four RCTs evaluated atherosclerosis in the coronary and two in the carotid arteries. High-dose OM3 significantly slowed the progression of atherosclerosis (standardized mean difference −1.97, 95% confidence interval −3.01, −0.94, p < 0.001). The results indicate that anti-atherosclerotic effect of high-dose OM3 is one potential mechanism in reducing CVD outcomes demonstrated in the REDUCE-IT trial.

Background: A recent systematic review showed Japan's mortality from chronic obstructive pulmonary disease (COPD) is the lowest among 204 countries, despite notably higher smoking rates in men in Japan than in the US. This study aims to compare (1) trends in smoking rates, (2) trends in COPD mortality, and (3) the spirometry-based COPD prevalence in the general adult population between Japan and the US.Methods: Age- and sex-specific smoking rates from the 1980s through 2010s and COPD mortality from 1999 through 2019 were obtained from national surveys and official statistics (International Classification of Diseases-10th codes J40-44), respectively. A systematic review and meta-analysis was performed to estimate COPD prevalence in Japan, while the National Health and Nutrition Examination Survey 2007-2012 was used for the US. A fixed ratio of 0.7 of forced expiratory volume in the first second of forced vital capacity was used to define COPD.Results: Over the past four decades, men in Japan consistently had 20-30% higher smoking rates than their US counterparts. From 1999-2019, age-adjusted COPD mortality in men in Japan was only a third of the US, whereas that in women was less than a tenth in 2019. Synthesizing data from 11 studies, involving 89,955 participants, Japan’s COPD prevalence was more than 10% lower than in the US in almost all age groups for both sexes.Conclusions: This study showed markedly lower rates of COPD in Japan than in the US. Investigating factors contributing to the paradoxical observations could lead to advancing COPD risk reduction strategies.

Background The significance of gastric xanthelasma in relation to gastric cancer still remains unclear. We investigated whether gastric xanthelasma would be a useful marker for predicting the development of early gastric cancer. Methods A total of 1823 patients who underwent a medical health checkup were enrolled. We examined the relationship between gastric xanthelasma and various clinical features, and in an endoscopic follow-up study investigated whether the presence of gastric xanthelasma was predictive of the development of early gastric cancer. Results In the initial endoscopic examination, gastric xanthelasma was detected in 107 (5.9 %) of the 1823 patients. The presence of gastric xanthelasma was significantly associated with age ≥65 years, male gender, open-type atrophy, and the presence of diabetes mellitus (DM) ( p < 0.0001, p < 0.0001, p < 0.0001, and p < 0.0001, respectively). During the endoscopic follow-up period, early gastric cancer was found in 29 (1.6 %) of the 1823 patients. Gastric cancer occurred in 15 (14.0 %) of 107 patients with gastric xanthelasma, whereas it occurred in 14 (0.8 %) of 1716 patients without ( p < 0.0001). Multivariate analysis revealed that open-type atrophy and gastric xanthelasma were independently related to the development of gastric cancer (odds ratio 7.19 [2.50–20.83]; p = 0.0003 and 5.85 [2.67–12.82]; p < 0.0001, respectively). The presence of gastric xanthelasma was significantly predictive of gastric cancer development even in the selected high-risk groups with open-type atrophy or DM ( p < 0.0001 or p < 0.0001, respectively). Conclusions Gastric xanthelasma is a useful marker for predicting the development of gastric cancer.

: This study evaluated the impact of the COVID-19 pandemic on trends of acute coronary syndrome hospitalizations, all-cause deaths, and ischemic heart disease (IHD) deaths in Allegheny County, Pennsylvania. : Inpatient hospital records from two hospital systems within Allegheny County, Pennsylvania, were aggregated from January 2017 to November 2020. The primary diagnoses were acute myocardial infarction (AMI) and unstable angina. The Pennsylvania Department of Health provided all-cause and IHD death counts for the same period. We compared absolute percentage changes in admissions by year (March-November) and trends by age-specific groups (<45, 45-64, 65-74, ≥75) from the pre-pandemic (January 2017-February 2020) to pandemic (March 2020-November 2020) period using an interrupted time-series analysis. : There were 11,913 AMI hospitalizations pre-pandemic and 2170 AMI hospitalizations during the pandemic period. AMI hospitalizations decreased by 14.8% and unstable angina hospitalizations decreased by 30.7% during the pandemic compared to 2019, with the largest decreases occurring in those aged ≥75. Total mortality increased by 9.2%, and IHD mortality increased by 2.4%. About 80% of the increase in deaths was due to COVID-19, and approximately 75% of deaths occurred in those aged ≥75 and in long-term care facility residents. : The COVID-19 pandemic did not markedly alter the longitudinal declining trend of AMI hospitalizations and IHD deaths in Allegheny County.

The present study introduces a concentration estimation model for indoor inhalable fine particles (PM2.5) during cooking activities in typical Kazakh houses, which are generally poorly ventilated with high emission levels. The aim of the present work is to identify factors influencing PM2.5 concentrations during cooking and elucidate the mechanisms underlying the build‐up and reduction of PM2.5 concentrations. These are achieved through a methodology that combines PM2.5 sampling, monitoring, and modeling to predict household PM2.5 levels and estimate daily concentrations. Specifically, USEPA's IAQX v1.1 was employed to simulate the one‐zone concept (kitchen) for concentrations related to cooking activities in several households. The results reveal that PM2.5 concentrations varied between 13 and 266 μg/m3 during cooking activities. Factors such as kitchen size, air exchange characteristics, and the type of food and cooking style were identified as important, influencing the observed concentrations. The model accurately captured concentration trends (R > 0.9). However, certain predictions tended to overestimate the measurements, attributing to inaccuracies in selecting air exchange and emission rates. Cooking activities contributed to household air pollutant (HAP) PM2.5 levels ranging from 9% to 94%. Notably, during the non‐heating period of the year (corresponding to the warmer half of the year), the impact of cooking became more significant and was identified as a major contributor to indoor PM2.5 concentrations. Conversely, during the heating period (i.e., the colder part of the year), outdoor PM levels and household ventilation practices played primary roles in regulating indoor air concentrations. This present study presents one of the initial efforts to assess household air pollutants in Central Asia, providing foundation and insights into the indoor air quality of Kazakh houses, where the understanding of indoor air quality remains limited. Future research recommendations include developing advanced models that account for individual activity patterns and specific house types for improved accuracy and representativeness. The cooking activity is a prominent contributor to indoor PM2.5 pollution. Kitchen size, air exchange, food type, and cooking style affect indoor air quality. The impact of the cooking activity peaks in the non‐heating period of the year.