Combined Effects of Smoking and Hypercholesterolemia on the Risk of Stroke and Coronary Heart Disease in Japanese: The Hisayama Study
Abstract
Background: Cigarette smoking is an established risk factor for stroke and coronary heart disease (CHD) in Western countries. However, it is uncertain whether or not smoking raises the risk of stroke in Japanese. We examined the influence of smoking on the development of stroke and CHD and the effects of interactions between smoking and hypercholesterolemia on these outcomes in a general Japanese population. Methods: A total of 2,421 community-dwelling Japanese individuals, aged 40–79 years, with no history of cardiovascular disease, were followed up for 14 years. Results: During the follow-up, 194 total stroke and 112 CHD events occurred. Compared with never smokers, the multivariate-adjusted hazard ratios for the occurrence of total stroke were 1.53 (95% confidence interval = 0.90–2.61) in former smokers, 1.90 (1.18–3.06) in current light smokers (<20 cigarettes/day) and 2.01 (1.11–3.65) in current heavy smokers (≧20 cigarettes/day). The multivariate-adjusted hazard ratios for the development of CHD were 1.10 (0.56–2.15), 1.88 (1.02–3.47) and 2.31 (1.17–4.57), respectively. In regard to stroke subtypes, current smoking was an independently significant risk factor for ischemic stroke and subarachnoid hemorrhage. Furthermore, the combination of smoking and hypercholesterolemia synergistically increased the risks of total stroke and CHD (all p for interaction <0.05). Conclusion: Our findings suggest that smoking raises the risks of ischemic stroke, subarachnoid hemorrhage and CHD occurrence in the Japanese population, and that this effect is strengthened by hypercholesterolemia.
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Japanese cohort studies have consistently reported smoking as a risk factor.
“Reviews in Japan alone have shown that smoking has been consistently reported in many cohort studies103–111) to be a risk factor.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [108]
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Kinoshita, M., Yokote, K., Arai, H., Iida, M., Ishigaki, Y., Ishibashi, S., Umemoto, S., Egusa, G., Ohmura, H., Okamura, T., et al. (2018) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.gl2017 · Cited by 813 · see citing works
- Authors
- Hata, J., Doi, Y., Ninomiya, T., Fukuhara, M., Ikeda, F., Mukai, N., Hirakawa, Y., Kitazono, T., & Kiyohara, Y.
- Affiliations
- Kyushu University (JP)
- Venue
- Cerebrovascular Diseases
- Publisher
- S. Karger AG
- Published
- 2011
- Volume
- 31
- Issue
- 5
- Pages
- 477-484
- ISSN
- 1015-9770 (ISSN-L)
- 1421-9786
- OpenAlex
- W2035581817
- Cited by
- 47
- References
- 28
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 4 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 6 · 2015: 4 · 2014: 5 · 2013: 6 · 2012: 4
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cerebrovascular Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Society for the Promotion of Science (22116001, 21590698, 22240073, 23590797)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- cigarette smoking, hypercholesterolemia, stroke, coronary artery disease, ischemic stroke, subarachnoid hemorrhage, cardiovascular risk factors, Japanese population, Hisayama Study
- MeSH terms
- Aged, Blood Pressure, Cerebrovascular Disorders, Coronary Disease, Data Interpretation, Statistical, Female, Follow-Up Studies, Glucose Tolerance Test, Health Surveys, Humans, Hypercholesterolemia, Japan, Male, Middle Aged, Population, Risk, Risk Factors, Smoking, Socioeconomic Factors, Subarachnoid Hemorrhage, Cohort Studies, Stroke, Asian People
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