We examined the relation between the serum total cholesterol level and the risk of death from stroke during six years of follow-up in 350,977 men, 35 to 57 years of age, who had no history of heart attack and were not currently being treated for diabetes mellitus. The diagnosis of stroke and the type of stroke were obtained from death certificates.

In western populations, coffee consumption is associated with a reduced risk for type 2 diabetes; however, the effect of green, black, and oolong teas is unclear. To examine the relationship between consumption of these beverages and risk for diabetes. Retrospective cohort study. 25 communities across Japan. A total of 17 413 persons (6727 men and 10 686 women; 49% of the original study population) who were 40 to 65 years of age; had no history of type 2 diabetes, cardiovascular disease, or cancer at the baseline lifestyle survey; and completed the 5-year follow-up questionnaire. There was no difference in body mass index levels at baseline between respondents and nonrespondents. Questionnaire on consumption of coffee; black, green, and oolong teas; and physician-diagnosed diabetes. During the 5-year follow-up, there were 444 self-reported new cases of diabetes in 231 men and 213 women (5-year event rates, 3.4% and 2.0%, respectively). Consumption of green tea and coffee was inversely associated with risk for diabetes after adjustment for age, sex, body mass index, and other risk factors. Multivariable odds ratios for diabetes among participants who frequently drank green tea and coffee (≥6 cups of green tea per day and ≥3 cups of coffee per day) were 0.67 (95% CI, 0.47 to 0.94) and 0.58 (CI, 0.37 to 0.90), respectively, compared with those who drank less than 1 cup per week. No association was found between consumption of black or oolong teas and the risk for diabetes. Total caffeine intake from these beverages was associated with a 33% reduced risk for diabetes. These inverse associations were more pronounced in women and in overweight men. Diabetes was self-reported, no data were available on consumption of soda, and the follow-up rate was low. Consumption of green tea, coffee, and total caffeine was associated with a reduced risk for type 2 diabetes. *For members of the JACC Study Group, see the Appendix.

An inverse relationship between fish intake and risk of stroke has been reported in several,^1,2 but not all,^3,4 prospective studies. Mechanisms for protection against stroke by fish intake may include inhibition of platelet aggregation^5,6; lowered blood viscosity⁶; suppressed formation of leukotrienes (lipid mediators for neutrophil and macrophage aggregation)⁷; and reduction of plasma fibrinogen⁸ blood pressure levels⁹ and insulin resistance.¹⁰ The possibility that fish consumption may increase the risk of hemorrhagic stroke was suggested by ecologic studies in which Greenland Eskimos with very high intake of omega-3 polyunsaturated fatty acids (omega-3 fatty acids) had an excess risk of mortality from hemorrhagic stroke compared with Danish whites.^11,12 However, the average food supply per capita for omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid) among persons living in the United States is about 0.1 to 0.2 g/d,¹³ much lower than that of Danish whites (0.8 g/d) and Greenland Eskimos (10.5 g/d).¹⁴ Thus, the potential for any increased risk of hemorrhagic stroke may be minimal at the average intake level of US residents. To our knowledge, no prospective study has examined previously the relationship between intake of fish and omega-3 fatty acids and risk of stroke by stroke subtype. We investigated this relationship prospectively during 14 years of follow-up. Our a priori hypothesis was that intake of fish and omega-3 fatty acids would be associated with reduced risk of ischemic stroke and would not be associated with increased risk of hemorrhagic stroke among middle-aged US women.

To examine sex-specific associations between sleep duration and mortality from cardiovascular disease and other causes. Cohort study. Community-based study. A total of 98,634 subjects (41,489 men and 57,145 women) aged 40 to 79 years from 1988 to 1990 and were followed until 2003. N/A. During a median follow-up of 14.3 years, there were 1964 deaths (men and women: 1038 and 926) from stroke, 881 (508 and 373) from coronary heart disease, 4287 (2297 and 1990) from cardiovascular disease, 5465 (3432 and 2033) from cancer, and 14,540 (8548 and 5992) from all causes. Compared with a sleep duration of 7 hours, sleep duration of 4 hours or less was associated with increased mortality from coronary heart disease for women and noncardiovascular disease/noncancer and all causes in both sexes. The respective multivariable hazard ratios were 2.32 (1.19–4.50) for coronary heart disease in women, 1.49 (1.02–2.18) and 1.47 (1.01–2.15) for noncardiovascular disease/noncancer, and 1.29 (1.02–1.64) and 1.28 (1.03–1.60) for all causes in men and women, respectively. Long sleep duration of 10 hours or longer was associated with 1.5- to 2-fold increased mortality from total and ischemic stroke, total cardiovascular disease, noncardiovascular disease/noncancer, and all causes for men and women, compared with 7 hours of sleep in both sexes. There was no association between sleep duration and cancer mortality in either sex. Both short and long sleep duration were associated with increased mortality from cardiovascular disease, noncardiovascular disease/noncancer, and all causes for both sexes, yielding a U-shaped relationship with total mortality with a nadir at 7 hours of sleep.

To examine the relation of triglycerides with coronary heart disease among populations with low mean total cholesterol, the authors conducted a 15.5-year prospective study ending in 1997 of 11,068 Japanese aged 40–69 years (4,452 men and 6,616 women with mean total cholesterol = 4.73 mmol/liter and 5.03 mmol/liter, respectively), initially free of coronary heart disease or stroke. There were 236 coronary heart disease events comprising 133 myocardial infarctions, 68 angina pectoris events, and 44 sudden cardiac deaths. The coronary heart disease incidence was greater in a dose-response manner across increasing quartiles of nonfasting triglycerides for both sexes. The multivariate relative risk of coronary heart disease adjusting for coronary risk factors and time since last meal associated with a 1-mmol/liter increase in triglycerides was 1.29 (95% confidence interval (CI): 1.09, 1.53; p = 0.004) for men and 1.42 (95% CI: 1.15, 1.75; p = 0.001) for women. The trend was similar for myocardial infarction, angina pectoris, and sudden cardiac death. The relation of triglycerides with coronary heart disease was not influenced materially by total cholesterol levels or, in a subsample analysis (51% of total sample), by high density lipoprotein cholesterol levels. Nonfasting serum triglycerides predict the incidence of coronary heart disease among Japanese men and women who possess low mean values of total cholesterol. Further adjustment for high density lipoprotein cholesterol suggests an independent role of triglycerides on the coronary heart disease risk.