This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kubo, M. Articles by Kiyohara, Y. Search for Related Content PubMed Articles by Kubo, M. Articles by Kiyohara, Y. Related Collections Risk Factors Cerebral Lacunes Primary and Secondary Stroke Prevention Epidemiology

(Circulation. 2008;118:2672-2678.)
© 2008 American Heart Association, Inc.

Heart Disease in Asia

Secular Trends in the Incidence of and Risk Factors for Ischemic Stroke and Its Subtypes in Japanese Population

Michiaki Kubo, MD, PhD^*; Jun Hata, MD, PhD^*; Yasufumi Doi, MD, PhD; Yumihiro Tanizaki, MD, PhD; Mitsuo Iida, MD, PhD; Yutaka Kiyohara, MD, PhD

From the Department of Environmental Medicine (M.K., J.H., Y.T., Y.K.) and Department of Medicine and Clinical Science (Y.D., M.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, and Laboratory for Genotyping Development (M.K.), Center for Genomic Medicine, The Institute of Physical and Chemical Research (RIKEN), Yokohama, Kanagawa, Japan.

Correspondence to Michiaki Kubo, MD, Laboratory for Genotyping Development, Center for Genomic Medicine, RIKEN, Suehiro-cho 1-7-22, Tsurumi, Yokohama, Kanagawa, 230-0045, Japan. E-mail mkubo{at}src.riken.jp

Background— 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.

---

 

CLINICAL PERSPECTIVE