TY - JOUR
T1 - Secular trends in the incidence of and risk factors for ischemic stroke and its subtypes in Japanese population
AU - Kubo, Michiaki
AU - Hata, Jun
AU - Doi, Yasufumi
AU - Tanizaki, Yumihiro
AU - Iida, Mitsuo
AU - Kiyohara, Yutaka
PY - 2008/12/23
Y1 - 2008/12/23
N2 - The study of long-term trends in the incidence of and risk factors for ischemic stroke subtypes could offer insights into primary and secondary prevention. Methods and Results-We established 3 cohorts of residents ≥ 40 years of age in 1961, 1974. and 1988 in the Japanese community of Hisayama. Morphological examinations by autopsy or brain imaging were performed on most of the ischemic stroke cases developed in these cohorts. When 13-year follow-up data were compared, the age-adjusted incidence of ischemic stroke and lacunar infarction declined significantly from the first to the third cohort for both sexes, whereas the incidences of atherothrombotic and cardioembolic infarction did not change during this period. Hypertension was a powerful risk factor for the development of ischemic stroke, and improvement of hypertension control would have largely influenced this declining trend: The age- and sex-adjusted hazard ratio of hypertension decreased from 3.25 (95% CI 2.17 to 4.86) in the first cohort to 1.83 (1.29 to 2.58) in the third cohort. A rapid increase in the prevalence of metabolic disorders may have offset the impact of improvements in hypertension control and resulted in a slowdown of the decline in the incidence of ischemic stroke in the cohorts in the present study: however, hypertension still makes a large contribution to the development of ischemic stroke. Conclusions-These findings suggest that in the Japanese population, the incidence of ischemic stroke has declined significantly over the past 40 years, probably owing to better management of hypertension. There is a need for greater primary prevention efforts in the treatment of hypertension and metabolic disorders.
AB - The study of long-term trends in the incidence of and risk factors for ischemic stroke subtypes could offer insights into primary and secondary prevention. Methods and Results-We established 3 cohorts of residents ≥ 40 years of age in 1961, 1974. and 1988 in the Japanese community of Hisayama. Morphological examinations by autopsy or brain imaging were performed on most of the ischemic stroke cases developed in these cohorts. When 13-year follow-up data were compared, the age-adjusted incidence of ischemic stroke and lacunar infarction declined significantly from the first to the third cohort for both sexes, whereas the incidences of atherothrombotic and cardioembolic infarction did not change during this period. Hypertension was a powerful risk factor for the development of ischemic stroke, and improvement of hypertension control would have largely influenced this declining trend: The age- and sex-adjusted hazard ratio of hypertension decreased from 3.25 (95% CI 2.17 to 4.86) in the first cohort to 1.83 (1.29 to 2.58) in the third cohort. A rapid increase in the prevalence of metabolic disorders may have offset the impact of improvements in hypertension control and resulted in a slowdown of the decline in the incidence of ischemic stroke in the cohorts in the present study: however, hypertension still makes a large contribution to the development of ischemic stroke. Conclusions-These findings suggest that in the Japanese population, the incidence of ischemic stroke has declined significantly over the past 40 years, probably owing to better management of hypertension. There is a need for greater primary prevention efforts in the treatment of hypertension and metabolic disorders.
UR - http://www.scopus.com/inward/record.url?scp=58249126972&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=58249126972&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.107.743211
DO - 10.1161/CIRCULATIONAHA.107.743211
M3 - Article
C2 - 19106389
AN - SCOPUS:58249126972
SN - 0009-7322
VL - 118
SP - 2672
EP - 2678
JO - Circulation
JF - Circulation
IS - 25
ER -