Cardioembolic stroke is the most serious problem in the aging society: Japan standard stroke registry study
Yuji Kato1, Takeshi Hayashi1, Norio Tanahashi1
1Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan.
Insights
In Japan's aging population, cardioembolic stroke is most common in older adults. Risk factors like hypertension and diabetes are key in younger stroke patients, while atrial fibrillation dominates in the elderly.
Area of Science:
- Geriatric Medicine
- Neurology
- Epidemiology
Background:
- Japan faces a rapidly aging population, presenting unique challenges in healthcare.
- Older individuals exhibit distinct stroke risk profiles and clinical presentations compared to younger demographics.
Purpose of the Study:
- To investigate stroke subtypes, risk factor prevalence, severity, and functional outcomes across different age groups in Japan.
- To understand the evolving landscape of stroke in an aging society.
Main Methods:
- A large-scale, multicenter hospital-based registration study.
- Inclusion of 78,096 patients with acute ischemic stroke (including transient ischemic attacks) from 95 Japanese institutes (2000-2012).
Main Results:
- Cardioembolic stroke and atrial fibrillation prevalence increased significantly in individuals over 90 years old.
- Increasing age correlated with more severe stroke symptoms and poorer functional outcomes.
- Hypertension peaked in the 70s, while diabetes and hyperlipidemia were most frequent in the 50s-60s.
Conclusions:
- Cardioembolic stroke is the predominant subtype in Japan's aging population.
- Hypertension, diabetes, and hyperlipidemia are significant risk factors in middle-aged stroke patients (50s-60s).
- Atrial fibrillation becomes a more critical factor for stroke in advanced age.
Background:
Japan has the fastest aging society in the world. Older patients have a different stroke risk profile and different stroke features compared with younger patients. The aim of the present study was to examine the stroke subtypes, risk factor profiles, stroke severities, and functional outcomes in the different age groups.
Methods:
A total of 78,096 patients with acute ischemic stroke, including transient ischemic attacks, were included in a multicenter, hospital-based registration study based on a computerized database involving 95 Japanese institutes between 2000 and 2012.
Results:
The frequency of atrial fibrillation increased even after the age of 90 years; consequently, the proportion of patients experiencing cardioembolic stroke also increased in the same age group. Furthermore, more severe symptoms on arrival and worse functional outcomes were observed with increasing age. The frequency of hypertension increased with age, peaking in patients in their 70s, and decreasing slightly thereafter. The frequency of diabetes mellitus and hyperlipidemia peaked in patients in their 50s or 60s and gradually decreased thereafter.
Conclusion:
The findings of the present study suggest that in the currently aging society, cardioembolic stroke is the most important stroke subtype. The roles of hypertension, diabetes mellitus, and hyperlipidemia are greatest in stroke patients in their 50s to 60s. In older patients, the role of atrial fibrillation is more significant.
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