Fundscopically identified risk factors for cerebrovascular disease (CVD) and heart disease (HD) were prospectively studied in 2, 112 men and women aged 30-59 who initially had no history of either disease and who lived in the Nishi-izu district of Shizuoka Prefecture.
Baseline medical examinations of the retinal arteries were made in a sample of 2, 112 residents in Nishi-izu Machi and Kamo Mura in 1964-1966 who were followed up until 1985. During the follow-up period, 93 died from CVD and 64 from HD.
Using a case-control study in a cohort study design, fundoscopically identified risk variables (hypertensive or arteriosclerotic changes in ocular fundus: fundoscopic classification by Scheie) were compared between the 157 cases (93 CVD cases and 64 HD cases) at the last health examination before death and 314 control survivors matched for gender, age (±2 years), and residential district. Using the same design, the progression of risk variables for 5±1 years prior to the last examination was followed to identify factors associated with circulatory disease.
From conditional logistic regression analyses using findings of the retinal arteries at the last health examination, significant risk variables for CVD were found to be the narrowing of retinal arteries and increases in reflex, whereas risk variables for HD were arteriovenous crossing (concealment) and increase in reflex.
From the same multivariate analyses using the progression of findings, significant risk variables for CVD were the ingravescence of the narrowing of retinal arteries and progressive increases in reflex, whereas for HD the only risk variables was progressive increases in reflex.
The present study suggested that, in addition to the cross-sectional findings of retinal arteries on a given occasion, the progression of findings through serial health examinations yields useful information for controlling the health of residents.

Patient Care ; Nurses ; Communication

Objective: BRCA1 and BRCA2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) by age 40 and 45, respectively. However, the carriers have a different way of thinking about their life plan. We aimed to investigate the distribution of age at diagnosis of ovarian cancer (OC) patients to examine the optimal timing of RRSO in the carriers. Methods: We examined a correlation between age at diagnosis of OC and common mutation types in 3,517 probands that received BRCA genetic testing. Among them, germline BRCA1 mutation (gBRCA1m), germline BRCA2 mutation (gBRCA2 m) and germline BRCA wild-type (gBRCAwt) were found in 185, 42 and 241 OC patients, respectively. Results: The average age at diagnosis of OC in gBRCA1m and gBRCA2 m was 51.3 and 58.3 years, respectively, and the difference from gBRCAwt (53.8 years) was significant. The gBRCA2 m carriers did not develop OC under the age of 40. The average age was 50.1 years for L63X and 52.8 years for Q934X in BRCA1, and 55.1 years for R2318X and 61.1 years for STOP1861 in BRCA2 . The age at diagnosis in L63X or R2318X carriers was relatively younger than other BRCA1 or BRCA2 carriers, however their differences were not significant. With L63X and R2318X carriers, 89.4% (42/47) and 100% (7/7) of women were able to prevent the development of OC, respectively, when RRSO was performed at age 40. Conclusion There appears to be no difference in the age at diagnosis of OC depending on the type of BRCA common mutation. Further analysis would be needed.