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Open Access Research article

Population Attributable Fraction of Smoking and Metabolic Syndrome on Cardiovascular Disease Mortality in Japan: a 15-Year Follow Up of NIPPON DATA90

Naoyuki Takashima1*, Katsuyuki Miura1, Atsushi Hozawa12, Aya Kadota1, Tomonori Okamura3, Yasuyuki Nakamura4, Takehito Hayakawa5, Nagako Okuda1, Akira Fujiyoshi1, Shin-ya Nagasawa1, Takashi Kadowaki1, Yoshitaka Murakami1, Yoshikuni Kita1, Akira Okayama6, Hirotsugu Ueshima1 and for the NIPPON DATA 90 Research group

Author Affiliations

1 Department of Health Science, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan

2 Department of Public Health, Yamagata University School of Medicine, Iida Nishi 2-2-1, Yamagata, Yamagata, 990-9585, Japan

3 Department of Preventive Cardiology, National Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka, 565-8565, Japan

4 The Cardiovascular Epidemiology, Kyoto Women's University, Imakumanokitahiyoshi-cho35, Kyoto, Kyoto, 605-8501, Japan

5 Department of Hygiene and Preventive Medicine, Fukushima Medical University, Hikarigaoka1, Fukushima, Fukushima, 960-1295, Japan

6 The First Institute for Health Promotion and Health Care, Japanese Anti-Tuberculosis Association, Misaki-cho1-3-12, Chiyoda, Tokyo, 101-061, Japan

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BMC Public Health 2010, 10:306  doi:10.1186/1471-2458-10-306

Published: 3 June 2010



Smoking and metabolic syndrome are known to be related to cardiovascular diseases (CVD) risk. In Asian countries, prevalence of obesity has increased and smoking rate in men is still high. We investigated the attribution of the combination of smoking and metabolic syndrome (or obesity) to excess CVD deaths in Japan.


A cohort of nationwide representative Japanese samples, a total of 6650 men and women aged 30-70 at baseline without history of CVD was followed for 15 years. Multivariate-adjusted hazard ratio for CVD death according to the combination of smoking status and metabolic syndrome (or obesity) was calculated using Cox proportional hazard model. Population attributable fraction (PAF) of CVD deaths was calculated using the hazard ratios.


During the follow-up period, 87 men and 61 women died due to CVD. The PAF component of CVD deaths in non-obese smokers was 36.8% in men and 11.3% in women, which were higher than those in obese smokers (9.1% in men and 5.2% in women). The PAF component of CVD deaths in smokers without metabolic syndrome was 40.9% in men and 11.9% in women, which were also higher than those in smokers with metabolic syndrome (7.1% in men and 3.9% in women).


Our results indicated that a large proportion of excess CVD deaths was observed in smokers without metabolic syndrome or obesity, especially in men. These findings suggest that intervention targeting on smokers, irrespective of the presence of metabolic syndrome, is still important for the prevention of CVD in Asian countries.