Background and Purpose-Few cohort studies have examined the association of carotid intima-media thickness (IMT) and plaque characteristics with the risk of stroke in apparently healthy persons. We examined the relationship of carotid IMT and the surface, morphology, and calcification of carotid plaques with the incidence of stroke among Japanese men. Methods-Carotid IMT and plaque were evaluated bilaterally with ultrasonography in 1289 men aged 60 to 74 years without a previous stroke or coronary heart disease. In this cohort, the subsequent incidence of stroke was investigated. Results-During the 4.5-year follow-up, 34 strokes occurred. The multivariate-adjusted relative risk (95% CI) for the highest versus lowest quartiles of maximum IMT of the common carotid artery (CCA; Ն1.07 versus Յ0.77 mm) was 3.0 (1.1 to 8.3) for stroke. The combination of CCA and internal carotid artery (ICA) wall thickness was a better predictor of the risk of stroke than was CCA wall thickness alone. Men with a plaque, defined as a focal wall thickness of Ն1.5 mm, in the ICA had a 3-fold higher risk of stroke than those without a plaque, and the plaque surface irregularity further increased the stroke risk. A significant excess risk of stroke was confined to men with an uncalcified plaque. Key Words: atherosclerosis Ⅲ carotid artery Ⅲ epidemiology Ⅲ risk factors Ⅲ stroke P rospective population-based studies in Europe and the United States have documented that carotid intima-media thickness (IMT) and plaque are positively associated with the subsequent incidence of stroke. 1-4 Furthermore, 2 prospective studies have investigated the association between echogenicity of plaques or carotid artery lesions and stroke risk in American populations; 1 study indicated that hypoechoic plaque was associated with increased risk of ischemic stroke, 5 and the other study implied that acoustic shadowing on carotid artery lesions is predictive of ischemic stroke. 6 In Asian countries, a previous follow-up study of Japanese patients with cardiovascular diseases or high-risk profiles showed a positive association between the severity of carotid plaque and the risk of ischemic stroke, 7 but no prospective study has been conducted in a general population. The aim of this prospective study was to systematically examine the incidence of stroke in relation to carotid IMT and the surface, morphology, and calcification of carotid plaque in community-dwelling Japanese elderly men. Conclusions-Increased Subjects and Methods Study PopulationSubjects comprised 1358 men aged 60 to 74 years who were all participants of the target ages in a cardiovascular risk survey between 1996 and 2000. Subjects lived in 1 urban and 2 rural communities in Japan (Minamitakayasu district in Yao City, an urban community in Osaka Prefecture, 278 miles west of Tokyo, with a total census of 23 552 in 2000; Ikawa town, a rural community in Akita Prefecture, 280 miles northeast of Tokyo, with a total census of 6116; and Noichi town, a rural community in Kochi Prefecture, 393 miles sout...

In this study this version of the GDS-15-J displayed excellent psychometric properties using a 6/7 cut off. Analyses suggest some items that might be removed in future studies of an abbreviated scale.

p Ͻ 0.001, †p Ͻ 0.05, ‡p Ͻ 0.01 (level compared with the immediately preceding period). 76Kitamura et al.

The metabolic syndrome is a major determinant of ischemic cardiovascular disease among middle-aged Japanese men and women, in particular among smokers.

Background and Purpose-We sought to examine the relationship between depressive symptoms and the incidence of stroke among Japanese men and women. Methods-A 10.3-year prospective study on the relationship between depressive symptoms and the incidence of stroke was conducted with 901 men and women aged 40 to 78 years in a rural Japanese community. Depressive symptoms were measured at baseline with the use of the Zung Self-Rating Depression Scale (SDS). The incidence of stroke was ascertained under systematic surveillance. Results-During the 10-year follow-up, 69 strokes (39 ischemic strokes, 10 intracerebral hemorrhages, 10 subarachnoid hemorrhages, and 10 unclassified strokes) occurred. Age-and sex-adjusted prevalence of mild depression (SDS scores Ն40) at baseline was 25% among subjects with incident stroke and 12% among subjects without stroke (PϽ0.01).Persons with SDS scores in the high tertile had twice the age-and sex-adjusted relative risk of total stroke as those with scores in the low tertile. The excess risk was confined to ischemic stroke. After we adjusted for body mass index, systolic blood pressure level, serum total cholesterol level, cigarette smoking, current treatment with antihypertensive medication, and history of diabetes mellitus, these relative risks remained statistically significant for total stroke (1.9; 95% CI, 1.1 to 3.5) and ischemic stroke (2.7; 95% CI, 1.2 to 6.0). Conclusions-Depressive symptoms predict the risk of stroke, specifically ischemic stroke among Japanese. (Stroke.2001;32:903-908.)

A smartphone can be used for effectively monitoring snoring and OSA in a controlled laboratory setting. Use of this technology in a noisy home environment remains unproven, and further investigation is needed.

Background and Purpose-Hypertension is a major risk factor for stroke. However, a substantial decrease in blood pressure levels in Japanese during the past 3 decades may have reduced contributions of hypertension to risk of stroke. The population attributable fraction, the percentage of outcomes attributable to exposure, of blood pressure for the incidence of stroke was investigated during 3 survey periods between 1963 and 1994 by means of a population-based cohort study. Methods-We explored 3 cohort data of residents aged 40 to 69 years in 4 Japanese communities in 1963 to 1971 (nϭ5439), 1975 to 1984 (nϭ9945), and 1985 to 1994 (nϭ11 788) baseline surveys. Mean follow-up period for each cohort was 10 years. Results-Higher blood pressure levels were associated with higher risk of stroke. Positive associations were also observed even within nonhypertension levels. From the first to the third cohorts, the blood pressure category with a majority of stroke incidence shifted from severe or moderate hypertension to mild hypertension. The population attributable fraction of the severe hypertension category in the first, second, and third cohorts were 20%, 14%, and 9%, respectively, and those of the moderate hypertension category were 19%, 24%, and 11%, respectively, whereas those of the mild hypertension category were 17%, 26%, and 23%, respectively. The results were similar when participants on antihypertensive medication were excluded. Conclusions-The higher risk of stroke incidence with higher blood pressure levels even in nonhypertension categories and the shift of stroke burden from severe/moderate hypertension to mild hypertension support the early management of hypertension and primary prevention of high blood pressures for the prevention of stroke.

No abstract