Incidence and Risk Factors for Subtypes of Cerebral Infarction in a General Population: The Hisayama Study
Abstract
Background and Purpose —We estimated the incidence of first-ever cerebral infarction in regard to its subtypes and analyzed their risk factors separately in a community-based prospective cohort study in Japan. Methods —Stroke-free subjects (n=1621) aged ≥40 years were followed up for 32 years from 1961. During this period, 298 cerebral infarctions occurred and were divided into 167 lacunar, 62 atherothrombotic, 56 cardioembolic, and 13 undetermined subtypes of infarction on the basis of clinical information including brain imaging and autopsy findings. Results —The age-adjusted incidence of lacunar infarction (3.8 per 1000 person-years for men and 2.0 for women) was higher than that of atherothrombotic infarction (1.2, 0.7) and cardioembolic infarction (1.3, 0.5) in both sexes. Time-dependent Cox’s proportional hazard analysis revealed systolic blood pressure as well as age to be independent risk factors for all subtypes of cerebral infarction except for cardioembolic infarction in men. Additionally, ST depression on ECG, glucose intolerance, and smoking in men and left ventricular hypertrophy on ECG and body mass index in women remained significant risk factors for lacunar infarction. ST depression was also significantly related to events of atherothrombotic infarction in women. The risk of atrial fibrillation for cardioembolic infarction was outstandingly high in both sexes, and left ventricular hypertrophy and lower total cholesterol were additional risk factors for cardioembolic infarction in women. Conclusions —In this Japanese population, lacunar infarction was the most common subtype of cerebral infarction and had a greater variety of risk factors, including not only hypertension but also ECG abnormalities, diabetes, obesity, and smoking, than did atherothrombotic infarction or cardioembolic infarction.
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High TC levels are associated with increased risk of ischemic stroke.
“an increased risk because of high TC levels was observed in ischemic stroke, as with in CAD58, 59).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [58]
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- Authors
- Tanizaki, Y., Kiyohara, Y., Kato, I., Iwamoto, H., Nakayama, K., Shinohara, N., Arima, H., Tanaka, K., Ibayashi, S., & Fujishima, M.
- Affiliations
- Kyushu University (JP)
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Venue
- Stroke
- Published
- 2000-11
- Volume
- 31
- Issue
- 11
- Pages
- 2616-2622
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2172036042
- Cited by
- 346
- References
- 33
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 3 · 2023: 9 · 2022: 4 · 2021: 9 · 2020: 14 · 2019: 14 · 2018: 9 · 2017: 9 · 2016: 11 · 2015: 11 · 2014: 15 · 2013: 18 · 2012: 14
- FWCI
- 10.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- cerebral infarction, lacunar infarction, atherothrombotic infarction, cardioembolic stroke, stroke incidence, risk factors, systolic blood pressure, hypertension, ST-segment depression, atrial fibrillation, left ventricular hypertrophy, impaired glucose tolerance, smoking, obesity, total cholesterol, sex differences, Japanese population
- MeSH terms
- Adult, Age Factors, Aged, Cerebral Infarction, Diabetes Mellitus, Female, Follow-Up Studies, Heart Diseases, Humans, Hypertension, Male, Middle Aged, Obesity, Risk Factors, Sex Factors, Smoking, Comorbidity, Incidence, Proportional Hazards Models
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