Secular Trends in the Incidence of and Risk Factors for Ischemic Stroke and Its Subtypes in Japanese Population
Secular Trends in the Incidence of and Risk Factors for Ischemic Stroke and Its Subtypes in Japanese Population
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DOI：
10.1161/circulationaha.107.743211
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发表时间：
2008-12-16
期刊：
影响因子：
37.8
通讯作者：
Kiyohara, Yutaka
中科院分区：
文献类型：
--
作者：
Kubo, Michiaki;Hata, Jun;Kiyohara, Yutaka
背景缺血性中风亚型的发病率和危险因素的长期趋势的研究可以提供洞察到初级和二级prevention.Methods和Results-We建立了3个队列的居民>= 40岁，在1961年，1974年和1988年在日本的久山社区。通过尸检或脑成像对这些队列中发生的大多数缺血性卒中病例进行形态学检查。当比较13年的随访数据时，年龄校正的缺血性卒中和腔隙性梗死的发病率从第一队列到第三队列在两种性别中均显著下降，而动脉粥样硬化血栓形成和心源性栓塞性梗死的发病率在此期间没有变化。高血压是发生缺血性卒中的重要危险因素，高血压控制的改善将在很大程度上影响这一下降趋势：年龄和性别校正的高血压风险比从第一队列的3.25（95%CI 2.17至4.86）降至第三队列的1.83（1.29至2.58）。代谢紊乱患病率的快速增加可能抵消了高血压控制改善的影响，并导致本研究队列中缺血性卒中发病率下降的减缓;然而，高血压仍然对缺血性卒中的发生有很大的贡献。结论-这些发现表明，在日本人群中，缺血性中风的发病率在过去40年中显著下降，这可能是由于对高血压的更好管理。在治疗高血压和代谢紊乱方面，需要加强初级预防工作。（循环。2008;118：2672-2678）。
Background-The study of long-term trends in the incidence of and risk factors for ischemic stroke subtypes could offer insights into primary and secondary prevention.Methods and Results-We established 3 cohorts of residents >= 40 years of age in 1961, 1974, and 1988 in the Japanese community of Hisayama. Morphological examinations by autopsy or brain imaging were performed on most of the ischemic stroke cases developed in these cohorts. When 13-year follow-up data were compared, the age-adjusted incidence of ischemic stroke and lacunar infarction declined significantly from the first to the third cohort for both sexes, whereas the incidences of atherothrombotic and cardioembolic infarction did not change during this period. Hypertension was a powerful risk factor for the development of ischemic stroke, and improvement of hypertension control would have largely influenced this declining trend: The age- and sex-adjusted hazard ratio of hypertension decreased from 3.25 (95% CI 2.17 to 4.86) in the first cohort to 1.83 (1.29 to 2.58) in the third cohort. A rapid increase in the prevalence of metabolic disorders may have offset the impact of improvements in hypertension control and resulted in a slowdown of the decline in the incidence of ischemic stroke in the cohorts in the present study; however, hypertension still makes a large contribution to the development of ischemic stroke.Conclusions-These findings suggest that in the Japanese population, the incidence of ischemic stroke has declined significantly over the past 40 years, probably owing to better management of hypertension. There is a need for greater primary prevention efforts in the treatment of hypertension and metabolic disorders. (Circulation. 2008;118:2672-2678.)