Trends in Stroke Incidence and Acute Case Fatality in a Japanese Rural Area

Morikawa, Yuko; Nakagawa, Hideaki; Naruse, Yuchi; Nishijo, Muneko; Miura, Katsuyuki; Tabata, Masaji; Hirokawa, Wataru; Kagamimori, Sadanobu; Honda, Machiko; Yoshita, Katsushi; Hayashi, Koich

doi:10.1161/01.str.31.7.1583

Cited by 95 publications

(74 citation statements)

References 25 publications

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“…The incidence of stroke, either thrombotic or hemorrhagic, has declined in accordance with stroke mortality [9][10][11][12][13][14][15] . Epidemiologic studies reveal that more than half the decline in stroke mortality can be explained by the decline in its incidence [9][10][11][12][13][14][15] .…”

Section: Trends In Incidence Of Stroke and Myocardial Infarctionmentioning

confidence: 99%

“…Epidemiologic studies reveal that more than half the decline in stroke mortality can be explained by the decline in its incidence [9][10][11][12][13][14][15] . It is also Age-adjusted all-stroke mortality for men and women peaked in 1965 and then declined substantially until 1990.…”

Section: Trends In Incidence Of Stroke and Myocardial Infarctionmentioning

confidence: 99%

“…A slight increase in 1995 for acute myocardial infarction was also due to the diagnostic change. 1955 1960 1965 1970 1975 1980 1985 1990 1995 true that the decline in CHD mortality since 1970 brought about the decline in the incidence of acute myocardial infarction [9][10][11][12][13][14][15][16] . The Hisayama Study compares the incidence of CHD as well as AMI, asymptomatic myocardial infarction and sudden death among three cohorts; the oldest is a survey taken during 1961-73, the second one during [1974][1975][1976][1977][1978][1979][1980][1981][1982][1983][1984][1985][1986], and the latest during 1988-2000 10) .…”

Section: Trends In Incidence Of Stroke and Myocardial Infarctionmentioning

confidence: 99%

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Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

Ueshima

2007

JAT

249

225

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Japan's age-adjusted rate for mortality from stroke increased after the Second World War until 1965 and then showed a significant decline until 1990; however, the age-adjusted rate for mortality from all heart disease and coronary heart disease (CHD) increased until 1970 and then declined slowly. A puzzling question is why the rate of mortality from CHD declined in spite of an increase in serum total cholesterol level following an increase in fat consumption. It was confirmed that CHD incidence was far lower in several Japanese populations compared to Western countries in the "Monitoring Trends and Determinants in Cardiovascular Disease" (MONICA) project; therefore, the lower CHD mortality in Japan stems from the lower CHD incidence. CHD risk factors based on epidemiologic cohort studies in Japan were no different from those of other industrialized countries: hypertension, hypercholesterolemia, smoking and diabetes mellitus (DM). So, how can we explain this phenomenon ? There are three possible explanations. One is the decline in population blood pressure level and the prevalence of hypertension during the years 1965-1990; the second is the decline in smoking rate in men and women; the third is that the serum total cholesterol level for middle-aged and elderly populations remains 5-15 mg/dL lower than that of the US elderly counterpart, although men aged 40-49 in Japan and the US had similar serum total cholesterol levels. It was also noted that elderly people in Japan, as observed in the Seven Countries Study, had far lower serum total cholesterol levels in midlife, i.e., around 160 mg/dL in the 1960s. This was not the case for elderly in the US where a higher serum total cholesterol level was observed in midlife. In conclusion, the lower serum cholesterol level in the past of Japanese middle-aged and elderly people compared to Western counterparts helps to maintain the low CHD incidence and mortality supported by the declining trend in blood pressure level and smoking rate for both men and women. J Atheroscler Thromb, 2007; 14:278-286.

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Section: Trends In Incidence Of Stroke and Myocardial Infarctionmentioning

confidence: 99%

Section: Trends In Incidence Of Stroke and Myocardial Infarctionmentioning

confidence: 99%

Section: Trends In Incidence Of Stroke and Myocardial Infarctionmentioning

confidence: 99%

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Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

Ueshima

2007

JAT

249

225

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“…21,22 Briefly, the city of Oyabe is located in Toyama Prefecture in the central part of Japan. Participants of this population-based cohort study, which was performed as a part of the Oyabe Study, consisted of 5074 residents (1569 men and 3505 women) aged 35 to 79 years who received medical check-ups for the population of Oyabe from May 1988 through November 1988.…”

Section: Study Populationmentioning

confidence: 99%

“…Details of this registration system were described previously. 21,22 In brief, this registration system of stroke has been continuously active for prevention of stroke and rehabilitation since 1967. Information regarding stroke was documented mainly for cases of hospitalization and outpatients by physicians of all general hospitals and general practitioners in Oyabe and general hospitals in neighboring cities.…”

Section: End Pointsmentioning

confidence: 99%

Comparison of Four Blood Pressure Indexes for the Prediction of 10-Year Stroke Risk in Middle-Aged and Older Asians

et al. 2004

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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...

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Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years

Carandang

Seshadri²,

Beiser³

et al. 2006

JAMA

442

304

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In this cohort of men and women free of prevalent clinical stroke at initial examination, incidence of stroke has decreased over the past 50 years but the lifetime risk has not declined to the same degree, perhaps due to improved life expectancy. The results of this study suggest that improved control of risk factors has lowered stroke incidence but emphasize the need for continued primary prevention efforts.

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Trends in Stroke Incidence and Acute Case Fatality in a Japanese Rural Area

Cited by 95 publications

References 25 publications

Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

Comparison of Four Blood Pressure Indexes for the Prediction of 10-Year Stroke Risk in Middle-Aged and Older Asians

Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years

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