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Epidemiology of Stroke in a General Japanese Population: The Hisayama Study

Jun Hata^1,2, Toshiharu Ninomiya^1,2

¹Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.

Journal of Atherosclerosis and Thrombosis

|May 31, 2023

Insights

The Hisayama Study shows declining stroke incidence due to better hypertension control, but rising metabolic risk factors increase atherothrombotic and embolic stroke risks. New models predict atherosclerotic cardiovascular disease and atrial fibrillation risk.

Area of Science:

Epidemiology
Cardiovascular Disease Research
Public Health

Background:

The Hisayama Study, established in 1961, tracks stroke, coronary artery disease (CAD), and noncommunicable diseases in a Japanese population.
Longitudinal data reveals decreasing systolic blood pressure in hypertensive individuals but increasing prevalence of metabolic risk factors like obesity and hypercholesterolemia.
While ischemic stroke incidence has declined due to improved hypertension management, atherothrombotic brain infarction (ATBI) and embolic stroke proportions have risen.

Approach:

Analyzes secular trends in stroke incidence and risk factor prevalence from the Hisayama Study.
Reviews associations between traditional risk factors and stroke development within the study cohort.
Develops risk prediction models for atherosclerotic cardiovascular disease (ASCVD) and atrial fibrillation (AF).

Key Points:

Hypertension management improvements have reduced overall ischemic stroke rates.
Increased metabolic risk factors and atrial fibrillation in an aging population contribute to a higher proportion of ATBI and embolic strokes.
Risk prediction models for ASCVD and AF are developed for clinical risk stratification.

Conclusions:

Comprehensive management of metabolic risk factors and atrial fibrillation is crucial to reduce ATBI and embolic stroke risks.
The developed models aim to stratify future risks of ASCVD and AF-related stroke in clinical practice and health examinations.
The Hisayama Study provides valuable long-term data for understanding and managing cardiovascular disease and stroke in a general population.

Read full analysis

Abstract:

The Hisayama Study is an ongoing epidemiological study of stroke, coronary artery disease (CAD), and other noncommunicable diseases in a general Japanese population established in 1961. According to the longitudinal data from the Hisayama Study, average levels of systolic blood pressure among hypertensive individuals have decreased with time since 1961. In contrast, the prevalence of metabolic risk factors such as obesity, hypercholesterolemia, and glucose intolerance has increased with time. The incidence rates of ischemic stroke in this population have declined significantly as a result of improvement in hypertension management, but the proportion of atherothrombotic brain infarction (ATBI) and embolic stroke among the total ischemic stroke cases have increased probably due to the increased prevalence of metabolic risk factors and the increased number of patients with atrial fibrillation (AF) with super-aging population. Therefore, a strategy to reduce the risks of ATBI and embolic stroke by comprehensive management of their risk factors is necessary.In this review, we first show the secular trends in the incidence of stroke and the prevalence of its risk factors using the data from the Hisayama Study. Then, the studies for the association of traditional risk factors with stroke development in the Hisayama Study are introduced. Finally, we developed risk prediction models to estimate the absolute risk of atherosclerotic cardiovascular disease (ASCVD; including ATBI and CAD) and AF, that may be used for the stratification of future risk of ATBI and AF-related stroke in clinical practice or health examination.

Keywords:

Atherothrombotic brain infarction Atrial fibrillation Epidemiology Risk factors Stroke

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