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Background and Purpose-Evidence of an inverse relationship between serum high-density lipoprotein cholesterol (HDL-C) and the risk of stroke is sparse in Asians and in women. The purpose of this investigation was to examine the relationship in a long-term cohort study of Japanese men and women among whom stroke occurrence is higher than in Western countries. Methods-A prospective cohort study was performed involving 4989 participants (1523 men, 3466 women) 35 to 79 years of age at baseline with Ϸ10 years of follow-up in a rural area of Japan. End points included all stroke incidence and ischemic stroke incidence. Results-During follow-up, 132 participants developed stroke, including 81 ischemic stroke cases. Age-adjusted incidence rates per 10 000 person-years for all stroke in subjects with low HDL-C (Ͻ30 mg/dL [0.78 mmol/L]) were 103.4 in men and 49.3 in women, which were remarkably higher than in subjects with high HDL-C (Ն60 mg/dL [1.56 mmol/L]) (26.4 in men and 15.5 in women). A similar relationship was observed for ischemic stroke. Multivariate-adjusted relative risks for all stroke incidence and ischemic stroke incidence were 2.89 (95% CI, 1.35 to 6.20) and 2.92 (95% CI, 1.17 to 7.32), respectively, for low versus high HDL-C participants. The relationships were independent of sex, age, body mass index, blood pressure, serum total cholesterol, alcohol consumption, and smoking. Conclusions-This 10-year follow-up study of Japanese men and women demonstrated that lower HDL-C levels were related significantly and independently to increased risk of all stroke incidence and ischemic stroke incidence.

Abstract-Information has been sparse on the comparison of 4 blood pressure (BP) indexes (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean BP [MBP]) in relation to long-term stroke incidence, especially in middle-aged and older Asian people. A prospective cohort study was performed in 4989 Japanese (1523 men and 3466 women) aged 35 to 79 at baseline with 10 years of follow-up. End points included stroke incidence (total, ischemic, and hemorrhagic). Multivariate-adjusted hazard ratios with a 1-SD higher value for each BP index were determined by Cox proportional hazard analyses; Wald 2 tests were used to compare the strength of relationships. Analyses were also done for each of 4 age-gender groups consisting of men and women aged 35 to 64 and 65 to 79 years. During follow-up, 132 participants developed stroke. Adjusted hazard ratios for all strokes were 1.68 for SBP, 1.72 for DBP, and 1.80 for MBP, which were higher than that for PP (1.34). SBP and DBP were related positively to stroke risk after adjustment of each other. PP was not the strongest predictor in any age-gender groups among 4 BP indexes. In men aged 65 to 79 years, SBP showed the strongest relationship to all stoke risk (hazard ratio 1.62) among 4 BP indexes. In women aged 65 to 79 years, hazard ratios for all strokes were 2.48 for MBP, 2.46 for DBP, 2.25 for SBP, and 1.57 for PP. The long-term incident stroke risk of high BP in Asians should be assessed by SBP and DBP together, or by MBP, not by PP. Key Words: stroke Ⅲ blood pressure Ⅲ epidemiology B lood pressure (BP) is an established major risk factor for coronary heart disease and stroke. 1-4 Risk relationships for systolic BP (SBP) and diastolic BP (DBP) are generally regarded to be continuous, graded, strong, independent of other risk factors, and etiologically significant. Some data indicate that SBP is a stronger predictor of cardiovascular diseases than DBP. 5-8 Several epidemiological studies reported that pulse pressure (PP), the difference between SBP and DBP, is a useful predictor for coronary heart disease, especially in older people. 9 -13 These reports emphasized the importance of PP as a coronary risk factor, especially because PP is often higher after age 50, apparently because of increased arterial stiffness. 14 -16 However, recent cohort studies including older people showed that the relationship of PP to mortality from total cardiovascular diseases and coronary heart disease was less strong than those of other BP indexes. [17][18][19][20] For stroke, 2 recent large-scale cohort study collaborations reported that PP was less useful in predicting long-term stroke risk than SBP. 19,20 Because a large part of the study participants in these studies were white (even in 1 study from the Asia Pacific region), investigations only for Asian people whose stroke occurrence is relatively higher than that in Western countries are sparse. Moreover, because most previous reports were on fatal stroke events and there would be more nonfatal stroke events not investigated, st...

An alcohol intake > or = 300 g/week was associated with significantly greater annual BP increase, and baseline BP was significantly higher in drinkers consuming > or = 200 g/week. It is necessary to limit alcohol intake to less than 200 g/week to prevent hypertension.