A prospective study of cerebrovascular disease in Japanese rural communities, Akabane and Asahi. Part 1: evaluation of risk factors in the occurrence of cerebral hemorrhage and thrombosis.

Okada, Hiroshi; Horibe, Hiroshi; Okamoto, Yoshiyuki; Hayakawa, Norihiko; Aoki, Nobuo

doi:10.1161/01.str.7.6.599

Cited by 110 publications

(64 citation statements)

References 22 publications

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“…19 " 21 In the present study the risk of cerebral hemorrhage increased markedly with elevation of both the systolic and the diastolic blood pressure. The results of multivariate analysis also demonstrated that systolic blood pressure was the most important of the various risk factors, followed by diastolic blood pressure.…”

supporting

confidence: 52%

“…23 In the present study, the risk was high in males in the high and low cholesterol groups and presented a U shape. Okada et al 21 reported similar results. However, on observation by systolic blood pressure level because blood pressure also tended to be high in the high cholesterol group, a tendency was found for the risk to be the higher the lower the cholesterol level in both the low and high blood pressure groups.…”

mentioning

confidence: 56%

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Cerebrovascular diseases in a fixed population of Hiroshima and Nagasaki, with special reference to relationship between type and risk factors.

Lin¹,

Shimizu²,

Kato³

et al. 1984

Stroke

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SUMMARY A study was made of the incidence of cerebrovascular disease, the chronological trends, and the relationship between the disease types and risk factors in 16,491 citizens of Hiroshima and Nagasaki. The subjects underwent medical examhiation at least once between 1958-74, and were free of cerebrovascular disease at the initial examination. During the 16-year period, 1.162 cases of cerebrovascular disease developed in the study population!, with diagnosis definite in 621. By type, there were 108 cases of cerebral hemorrhage, 469 cases of cerebral infarction, 33 cases of subarachnoid hemorrhage, and 11 cases of other unclassifiable types. As a risk factor of cerebral hemorrhage, elevation of systolic and diastolic blood pressure was the most closely related to onset, and left ventricular hypertrophy on electrocardiogram (ECG), and proteinuria were also related. However, a tendency was seen for the risk to be higher when the levels of serum cholesterol were lower. In cerebral infarction, aging like systolic blood pressure, was a most important risk factor. Left ventricular hypertrophy on ECG, proteinuria, and diabetes could also be risk factors. However, the relation to blood pressure, especially diastolic blood pressure, was not so great as in the case of cerebral hemorrhage. Stroke Vol 15, No 4, 1984 IT HAS BEEN REPORTED that cerebrovascular diseases occur at a higher incidence in Japan than coronary heart disease, which by contrast occurs more frequently in Europe and America. 1 -2 Cerebral arteriosclerosis is considered to be a factor for the high incidence of cerebrovascular diseases in the Japanese, with cerebral arteriosclerosis probably playing a major role. 3 Rickert et al. 4 reported that sclerotic lesions of the coronary artery were very mild in the Japanese despite comparatively marked atherosclerosis of the aorta and cerebral arteries.According to a recent report, 5 a decrease in the incidence and mortality of cerebrovascular diseases has occurred in the Japanese during the past 10 or more years. There has been a marked decrease of cerebral hemorrhage, and the cerebral hemorrhage to cerebral infarction ratio has tended to decrease yearly. Although there was a reported difference in the risk factors of cerebrovascular diseases by type, the development of both cerebral hemorrhage and cerebral infarction, had a close correlation to hypertension. 6 According to a WHO report, 7 development of cerebrovascular diseases in the Japanese was closely related to hypertension and not too closely related to diabetes, hypercholesteremia, and obesity.

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confidence: 52%

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confidence: 56%

Cerebrovascular diseases in a fixed population of Hiroshima and Nagasaki, with special reference to relationship between type and risk factors.

Lin¹,

Shimizu²,

Kato³

et al. 1984

Stroke

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“…57 Prior ischemic infarct increases the relative risk of ICH by 5-to 20-fold. [75][76][77] Prior ICH is a risk factor for stroke overall, with a risk of about 1.2% per year for occurrence of either recurrent ICH or ischemic stroke. 77 …”

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confidence: 99%

Update in Intracerebral Hemorrhage

Aguilar

Brott

2011

The Neurohospitalist

127

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Spontaneous, nontraumatic intracerebral hemorrhage (ICH) is defined as bleeding within the brain parenchyma. Intracranial hemorrhage includes bleeding within the cranial vault and encompasses ICH, subdural hematoma, epidural bleeds, and subarachnoid hemorrhage (SAH). This review will focus only on ICH. This stroke subtype accounts for about 10% of all strokes. The hematoma locations are deep or ganglionic, lobar, cerebellar, and brain stem in descending order of frequency. Intracerebral hemorrhage occurs twice as common as SAH and is equally as deadly. Risk factors for ICH include hypertension, cerebral amyloid angiopathy, advanced age, antithrombotic therapy and history of cerebrovascular disease. The clinical presentation is ''stroke like'' with sudden onset of focal neurological deficits. Noncontrast head computerized tomography (CT) scan is the standard diagnostic tool. However, newer neuroimaging techniques have improved the diagnostic yield in terms of underlying pathophysiology and may aid in prognosis. Intracerebral hemorrhage is a neurological emergency. Medical care begins with stabilization of airway, breathing function, and circulation (ABCs), followed by specific measures aimed to decrease secondary neurological damage and to prevent both medical and neurological complications. Reversal of coagulopathy when present is of the essence. Blood pressure management can be key and continues as an area of debate and ongoing research. Surgical evacuation of ICH is of unproven benefit though a subset of well-selected patients may have improved outcomes. Ventriculostomy and intracranial pressure (ICP) monitoring are interventions also used in this patient population. To date, hemostatic medications and neuroprotectants have failed to result in clinical improvement. A multidisciplinary approach is recommended, with participation of vascular neurology, vascular neurosurgery, critical care, and rehabilitation medicine as the main players.

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“…In Japan, however, some ecological studies compared stroke incidence rates among several defined populations, and showed that the rates were inversely correlated with mean serum cholesterol and fat intake (3,4). Afterwards, some cohort studies indicated that the level of serum cholester ol was inversely associated with the risk of stroke; particularly cerebral hemorrhage and cerebral infarction in perforating artery regions after adjustment for some confounding variables such as sex, age and blood pressure (5)(6)(7).…”

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confidence: 99%

Dietary Lipids and Incidence of Cerebral Infarction in a Japanese Rural Community.

Seino¹,

Date

Nakayama³

et al. 1997

Journal of Nutritional Science and Vitaminology, J Nutr Sci Vit

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SummaryObjective: To assess the relationship between dietary lipids and incidence of cerebral infarction in a Japanese rural population. Design: A cohort study from July 1977 through December 1992. Setting: Akadani-Ijimino (A-I) district, Niigata Prefecture, Japan. Subjects and methods: All the residents, 1,182 men and 1,469 women, aged 40 years and over. Out of these members, 954 men and 1,329 women who were initially free of stroke completed a semiquantitative food frequency ques tionnaire in 1977, and were then subjected to a follow-up for 15.5 years. The occurrence of stroke was determined by the annual follow-up exam ination and registry. Dietary lipid was adjusted for total energy or fat intake by the residual method. Sex and age-stratified and blood pressure and atrial fibrillation-adjusted relative risk for cerebral infarction was estimated by the Cox proportional hazard model. Results: There were 75 new cases of cerebral infarction during the observation period. The relative risk for cerebral infarction was less than one in the highest quartile level of total fat, saturated fatty acids (S), Keys score and west ernized dietary pattern: 0.68-0.94. It ranged between 1.36 and 1.57 in the highest level of polyunsaturated (P), n-3 and n-6 fatty acids, and P/S ratio. Conclusion: This study suggests the possibility that the traditional Japanese diet, very low fat intake, was likely to increase the risk of stroke through the low level of serum cholesterol as an intermediary factor. Key Words dietary lipids, cerebral infarction, cohort study, serum cho lesterol, "diet-stroke" hypothesis According to the "diet-heart" hypothesis (1, 2), a high intake of saturated fatty acids and cholesterol and low intake of polyunsaturated fatty acids increase the 83 84 F. SEINO et al. level of serum cholesterol, and hypercholesterolemia results in the occurrence of coronary heart disease and stroke. In Japan, however, some ecological studies compared stroke incidence rates among several defined populations, and showed that the rates were inversely correlated with mean serum cholesterol and fat intake (3, 4). Afterwards, some cohort studies indicated that the level of serum cholester ol was inversely associated with the risk of stroke; particularly cerebral hemorrhage and cerebral infarction in perforating artery regions after adjustment for some confounding variables such as sex, age and blood pressure (5-7).To date, however, there have been few prospective studies on the relationship between dietary fat and stroke among Japanese in Japan. Using all of the residents aged 40 years and over in Akadani-Ijimino district (hereinafter referred to as A-I district), Shibata City, Niigata Prefecture, Japan, their dietary lipid intakes were assessed by a semiquantitative food frequency questionnaire in July 1977. Those who were initially free of stroke have been subjected to a follow-up ever since. In this report, we deal with the relationship of dietary lipid intake to the subsequent 15.5-year incidence of cerebral infarction which sho...

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A prospective study of cerebrovascular disease in Japanese rural communities, Akabane and Asahi. Part 1: evaluation of risk factors in the occurrence of cerebral hemorrhage and thrombosis.

Cited by 110 publications

References 22 publications

Cerebrovascular diseases in a fixed population of Hiroshima and Nagasaki, with special reference to relationship between type and risk factors.

Cerebrovascular diseases in a fixed population of Hiroshima and Nagasaki, with special reference to relationship between type and risk factors.

Update in Intracerebral Hemorrhage

Dietary Lipids and Incidence of Cerebral Infarction in a Japanese Rural Community.

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