Mortality and risk factors for stroke and its subtypes in a cohort study in Japan

Pham, Truong-Minh; Fujino, Yoshihisa; Tokui, Noritaka; Ide, Reiko; Kubo, Toshikazu; Shirane, Kiyoyumi; Mizoue, Tetsuya; Ogimoto, Itsuro; Yoshimura, Takesumi

doi:10.1016/j.ypmed.2007.02.016

Cited by 22 publications

(31 citation statements)

References 23 publications

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“…The meta-analysis performed using the RR or HR adjusted for all the confounders accounted for in each study also indicated a direct association with overweight and obesity ( Table 2, combined effect I). The results were similar on inclusion of 5 additional studies [42][43][44][45][46] that did not provide crude unadjusted data and thus were not included in the basic meta-analysis (Table 2, combined effect II).…”

Section: Ischemic Strokementioning

confidence: 77%

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Excess Body Weight and Incidence of Stroke

Strazzullo

D’Elia

Cairella

et al. 2010

Stroke

428

160

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Background and Purpose-A systematic review of the prospective studies addressing the relationship of overweight and obesity to major stroke subtypes is lacking. We evaluated the occurrence of a graded association between overweight, obesity, and incidence of ischemic and hemorrhagic stroke by a meta-analysis of cohort studies. Methods-A search of online databases and relevant reviews was performed. Inclusion criteria were original article in English, prospective study design, follow-up Ն4 years, indication of number of subjects exposed, and number of events across body mass index categories. Crude unadjusted relative risk (RR) and 95% CI were calculated for each study for overweight or obese compared with normal-weight categories. Log-transformed values and SE were used to calculate the pooled RR with random effects models; publication bias was checked. Additional analyses were performed using the multivariate estimates of risk reported in the individual studies. Results-Twenty-five studies were included, with 2 274 961 participants and 30 757 events. RR for ischemic stroke was 1.22 (95% CI, 1.05-1.41) for overweight and 1.64 (95% CI, 1.36 -1.99) for obesity, whereas RR for hemorrhagic stroke was 1.01 (95% CI, 0.88 -1.17) and 1.24 (95% CI, 0.99 -1.54), respectively. Subgroup and meta-regression analyses ruled out gender, population average age, body mass index and blood pressure, year of recruitment, year of study publication, and length of follow-up as significant sources of heterogeneity. The additional analyses relying on the published multivariate estimates of risk provided qualitatively similar results. Conclusions-Overweight and obesity are associated with progressively increasing risk of ischemic stroke, at least in part, independently from age, lifestyle, and other cardiovascular risk factors. (Stroke. 2010;41:e418-e426.)Key Words: body mass index Ⅲ cerebrovascular disease Ⅲ excess body weight Ⅲ meta-analysis Ⅲ stroke S troke is a major cause of death in developed countries. Its prevalence and disability burden are expected to increase in the future because of population aging. 1 Besides age, risk factors include hypertension, smoking, diabetes mellitus, left ventricular hypertrophy, and atrial fibrillation. 2 Obesity is a precursor of hypertension, diabetes, and their complications, which play an important indirect role in the epidemiology of stroke; moreover, it is associated with the action of powerful cytokines impacting on the sympathetic nervous system activity, the renin-angiotensin axis, the endothelial function, and the microcirculation. 3 Randomized, controlled trials of the effects of treating obesity on the risk of stroke are lacking. Recently, a large collaborative study provided prospective results about the relationship between obesity and mortality from stroke on a total population of nearly 900 000 individuals, mainly from Western countries, but it did not provide incidence rates, which are actually a more informative index of the burden imposed by stroke on the community. 4 Another r...

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Section: Ischemic Strokementioning

confidence: 77%

“…After inclusion of the aforementioned 5 additional studies, [42][43][44][45][46] the association between hemorrhagic stroke and obesity was missed ( Table 2, combined effect II). Also, the meta-analysis of the studies that provided RR or HR adjusted for age only did not provide evidence of association either with obesity (11 cohorts …”

Section: Hemorrhagic Strokementioning

confidence: 99%

Excess Body Weight and Incidence of Stroke

Strazzullo

D’Elia

Cairella

et al. 2010

Stroke

428

160

View full text Add to dashboard Cite

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“…Interestingly, many Japanese cohort studies have reported an increased risk of fatal strokes among individuals with low body weight rather than overweight individuals. The multivariable-adjusted hazard ratios for stroke mortality of subjects with BMIs of o18.5 kg m -2 were 1.7 (1.07, 2.63) for both men and women in the Miyako study, 16 1.50…”

Section: Discussionmentioning

confidence: 90%

Body mass index, weight change and risk of stroke and stroke subtypes: the Japan Public Health Center-based prospective (JPHC) study

et al. 2010

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Objective: The Japan Public Health Center-based prospective Study examined the association of body mass index (BMI) and weight change with incident stroke in Japanese individuals, for whom BMI levels are generally low. Methods: We used initial data from 1990 to 1994 and 5-year follow-up surveys from 1995 to 1999. We calculated weight change over a 5-year period for 32 847 men and 38 875 women, aged 45-74 years, with no history of cardiovascular disease or cancer. Subjects were followed from the 1995-1999 survey to the end of 2005, and hazard ratios of self-reported BMI levels and weight change for incident stroke were estimated using Cox's proportional hazard models adjusted for potential confounders. Results: During the follow-up period (median 7.9 years) there were 2019 incident strokes, including subtypes. Multivariableadjusted hazard ratios for all stroke events by BMI levels of 27.0-29.9 and X30 kg m -2 versus 23.0-24.9 kg m -2 were 1.09 (95% confidence interval 0.88, 1.36) and 1.25 (0.86, 1.84) in men (P for trend ¼ 0.22), and 1.29 (1.01, 1.65) and 2.16 (1.60, 2.93) in women (P for trend o0.001), respectively. A weight change of X10% in the previous 5 years was associated with total strokes and ischemic strokes in women. Conclusion: Higher BMI levels and a weight gain of X10% over 5 years were associated with an increased risk of stroke in women, whereas this association was weak in men.

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“…27,28 Being overweight was associated with mortality from coronary heart disease, but not from hemorrhagic or ischemic stroke, which was also consistent with previous Japanese studies. [29][30][31][32][33] The strengths of our study include the long term followup, sufficient number of deaths, complete follow-up of subjects using basic resident registers and systematic review of death certificates, and gender-specific analysis. To our knowledge, this study is the first large-scale prospective study of the Japanese general population to evaluate the gender-specific impact of each metabolic risk factor to mortality from CVD, stratified by BMI.…”

Section: Discussionmentioning

confidence: 99%