Incidence and Risk Factors for Subtypes of Cerebral Infarction in a General Population

Tanizaki, Yumihiro; Kiyohara, Yutaka; Kato, Ikunoshin; Iwamoto, Hisao; Nakayama, Katsuhiro; Shinohara, Nobuyuki; Arima, Hisatomi; Tanaka, Keiichi; Ibayashi, Setsuro; Fujishima, Masatoshi

doi:10.1161/01.str.31.11.2616

Cited by 328 publications

(286 citation statements)

References 44 publications

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“…Our finding adds to existing evidence that diabetes raises the risk of lacunar infarction in both sexes, since a previous Japanese study showed a significant independent association only among men [4]. It is plausible that glucose abnormality or insulin resistance causes microangiopathy, with arteriosclerosis in small penetrating arterioles of the cerebral basal ganglia, leading to lacunar infarction [16].…”

Section: Discussionsupporting

confidence: 74%

“…Due to the fact that a previous Japanese study [4] reported that the relationship between diabetes and risk of ischaemic stroke varied according to sex, we conducted sex-specific analyses in addition to sex-adjusted analyses.…”

Section: Methodsmentioning

confidence: 99%

“…However, data on Japanese people living in Japan and on other Asian populations are extremely limited [4]. Due to the lower prevalence of diabetes in Asia compared with that in Western countries [5], the majority of existing cohort studies in Asia may have a low statistical power for detecting an association between diabetes and risk of ischaemic stroke.…”

Section: Introductionmentioning

confidence: 99%

“…Because hypertension is a primary risk factor for ischaemic stroke [1,4], we postulated that the increased prevalence of diabetes and obesity and the decreased blood pressure levels may increase the relative contribution of diabetes to the development of ischaemic stroke. To investigate whether diabetes is a significant predictor of ischaemic stroke in Japanese men and women, particularly in non-hypertensive and non-lean individuals, we analysed data from a large prospective study of 10,000 middle-aged men and women in five Japanese communities.…”

Section: Introductionmentioning

confidence: 99%

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Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women

et al. 2004

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Aims/hypothesis. The aim of this study was to examine the relationship between type 2 diabetes and risk of ischaemic stroke in Asian populations. Methods. We conducted a 17-year prospective cohort study in 10,582 Japanese individuals (4287 men and 6295 women) aged 40-69 years living in five communities in Japan. All subjects were free of stroke and CHD at baseline. Diabetes was defined as a fasting glucose level of ≥7.0 mmol/l, a non-fasting glucose of ≥11.1 mmol/l, or receiving medication for diabetes.Results. The risk of non-embolic ischaemic stroke was approximately two-fold higher in diabetic subjects than in subjects with normal glucose levels. The multivariate relative risk after adjustment for age, community, hypertensive status, BMI, triceps and subscapular skinfold thickness (TSF and SSF), and other known cardiovascular risk factors was 1.8 (95% CI 1.0-3.2) for men and 2.2 (1.2-4.0) for women. This excess risk was primarily observed among non-hypertensive subjects and individuals with higher values for measures of adiposity (BMI, TSF and SSF values above the median), particularly those with higher values for SSF. The association between non-embolic ischaemic stroke and glucose abnormality was particularly strong among nonhypertensive subjects with higher SSF values: the multivariate relative risk was 1.9 (1.0-3.7) for borderline diabetes and 4.9 (2.5-9.5) for diabetes. Conclusions/interpretation. In this cohort, type 2 diabetes was a significant risk factor for non-embolic ischaemic stroke, particularly in non-hypertensive and non-lean individuals. Due to the nationwide decrease in blood pressure and increase in mean BMI among the Japanese population, with current levels approaching those observed in Western countries, the impact of glucose abnormalities on risk of ischaemic stroke represents a forthcoming public health issue in Japan.

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Section: Discussionsupporting

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women

et al. 2004

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“…21,22 Based on its pathogenesis, stroke is divided into several clinical subtypes, and the effects of BMI on stroke are considered to be different among these subtypes. 8,19 In addition, obesity is an important risk factor for hypertension, diabetes mellitus and dyslipidemia, which are known as major risk factors for stroke, 23,24 and therefore, whether obesity itself independently increases the risk of stroke remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Body mass index and stroke incidence in a Japanese community: the Hisayama study

et al. 2010

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Although obesity is one of the major risk factors for coronary heart disease, its role in the development of stroke remains controversial. A total of 2421 residents, aged 40-79 years of a Japanese community were followed up prospectively for 12 years. The subjects were divided into four groups according to body mass index (BMI) levels (o21.0, 21.0-22.9, 23.0-24.9 and X25.0 kg m À2 ). During the follow-up, 107 ischemic and 51 hemorrhagic strokes occurred. The age-adjusted incidence of ischemic stroke for men significantly increased with increasing BMI levels (P for trend¼0.005). This association remained substantially unchanged even after adjustment for other risk factors: namely, systolic blood pressure, electrocardiogram abnormalities, diabetes, total cholesterol, high-density lipoprotein-cholesterol, triglycerides, smoking habits, alcohol intake and regular exercise (P for trendo0.001). Compared with that of the BMI levels of o21.0 kg m À2 , the multivariate-adjusted risk of ischemic stroke was significant even in the BMI levels of 23.0-24.9 kg m À2 (multivariate-adjusted hazard ratio (HR)¼3.12; 95% confidence interval (CI), 1.24-7.87; P¼0.02) as well as in the BMI levels of X25 kg m À2 (multivariate-adjusted HR¼5.59; 95% CI, 2.09-14.91; Po0.001). In stratified analyses, the risk of ischemic stroke for men synergistically increased in subjects having both obesity and diabetes or a smoking habit. We found no significant associations between BMI levels and ischemic stroke in women and between BMI levels and hemorrhagic stroke in either sex. In conclusion, our findings suggest that overweight and obesity are independent risk factors for ischemic stroke in Japanese men.

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Validity of the JNC VI Recommendations for the Management of Hypertension in a General Population of Japanese Elderly

Arima¹,

Tanizaki²,

Kiyohara³

et al. 2003

Arch Intern Med

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103

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Background: It is not known whether the treatment recommendations presented in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure are applicable to the Japanese elderly population. Methods: We followed up 588 cardiovascular diseasefree residents of a Japanese community who were 60 years or older from November 1, 1961, through October 31, 1993. Treated hypertensive patients were excluded from the analysis. During this period, CVD occurred in 179 subjects. The incidences were estimated by the pooling of repeated observations method. Results: The age-and sex-adjusted incidences of cardiovascular disease significantly increased with elevated blood pressure levels. The hazard ratio for stage 3 hypertension was 5.34 (95% confidence interval, 2.66-10.71; P<.001) compared with optimal blood pressure after adjustment for other covariates. Among subjects aged 60 to 79 years, the incidences for stages 1 through 3 hy-pertension were significantly higher than for those with optimal and normal blood pressure. In comparison, among those 80 years or older, the incidence was significantly higher only in patients with stage 3 hypertension. We further estimated the incidences according to the risk stratification system. In the younger elderly subjects, the incidences increased with rising blood pressure levels in each risk stratum. Similar relationships were not observed among the older elderly subjects. Conclusions: Our findings demonstrate that the recommendations of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure were potentially applicable to the Japanese elderly subjects 79 years or younger. Based on our findings, however, hypertension might not be a risk factor for cardiovascular disease among very old hypertensive patients with advanced atherosclerosis.

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Incidence and Risk Factors for Subtypes of Cerebral Infarction in a General Population

Cited by 328 publications

References 44 publications

Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women

Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women

Body mass index and stroke incidence in a Japanese community: the Hisayama study

Validity of the JNC VI Recommendations for the Management of Hypertension in a General Population of Japanese Elderly

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