Trends in Prevalence of Non-Valvular Atrial Fibrillation and Anticoagulation Therapy in a Japanese Region　- Analysis Using the National Health Insurance Database.

BACKGROUND: Direct oral anticoagulants (DOACs) are effective in reducing thromboembolism events in patients with non-valvular atrial fibrillation (NVAF). However, little is known about trends in NVAF prevalence and DOAC prescriptions in daily clinical practice. This study investigated the current status and trends in NVAF prevalence and DOAC prescriptions in a region of Japan.Methods and Results:Annual data for the 4 years from May 2014 to May 2017 in the Tsugaru region of Aomori Prefecture, Japan, were obtained for analysis from the Japanese National Health Insurance database ("Kokuho" database [KDB]). The prevalence of NVAF in subjects aged 40-74 years increased gradually over the 4-year study period (1,094/57,452 [1.90%] in 2014, 1,055/56,018 [1.88%] in 2015, 1,072/54,256 [1.98%] in 2016, and 1,154/52,341 [2.20%] in 2017). The proportion of NVAF patients prescribed warfarin decreased (42%, 33%, 24%, and 21% in 2014, 2015, 2016, and 2017, respectively), the proportion of those prescribed DOACs increased (30%, 42%, 50%, and 57%, respectively), and the proportion not prescribed an oral anticoagulant (OAC) decreased (28%, 25%, 26%, and 22%, respectively). However, 17% of patients with a CHADS2score ≥2 were not prescribed an OAC in 2017. CONCLUSIONS: By using the KDB we found that the prevalence of NVAF has increased gradually from 2014 to 2017. In the Tsugaru region in Japan, DOACs prescriptions increased and warfarin prescriptions decreased over the 4-year period.

The Risk of Helicobacter Pylori Infection and Atrophic Gastritis from Food and Drink Intake: a Cross-sectional Study in Hokkaido, Japan.

One-hundred and fifteen subjects were diagnosed with Helicobacter pylori (HP) infection and 93 subjects with atrophic gastritis (AG) from tests of HP antibodies or serum levels of pepsinogen I and pepsinogen II involving 210 inhabitants, who participated in the health check-up program. Logistic regression analysis found that refreshing (isotonic) beverages significantly reduced the risk of HP infection (odds ratio: 0.767, 95% C.I.: 0.616-0.956). A higher frequency of intake for margarine (odds ratio: 1.413, 95% C.I.: 1.080-1.848), cheese (odds ratio: 1.416, 95% C.I.: 1.044-1.920), Tsukemono (odds ratio: 1.277, 95% C.I.: 1.000-1.631) or Cola-beverages (odds ratio: 1.471, 95% C.I.: 1.051-1.239) showed a significantly increased risk of AG. In addition, high serum values of &mgr;-carotene (odds ratio: 0.691, 95%C.I.: 0.498-0.958), linoleic acid (odds ratio: 0.594, 95%C.I.: 0.382-0.924), and &mgr;-linolenic acid (odds: 0.987, 95%C.I.: 0.976-0.998) were found to reduce the risk of AG, but not HP infection. Furthermore, these results suggest that a more frequent intake of margarine, Tsukemono (pickled vegetables), or Cola-beverages may be a risk factor for AG, while foods rich in carotenes, such as, &mgr;-carotene and n-6PUFAs, such as &mgr;-linolenic acid, may reduce the risk of AG.