Decreasing incidence of lacunar vs other types of cerebral infarction in a Japanese population

• Published in: Neurology Vol. 66; no. 10; pp. 1539 - 1544
• Main Authors: KUBO, M, KIYOHARA, Y, NINOMIYA, T, TANIZAKI, Y, YONEMOTO, K, DOI, Y, HATA, J, OISHI, Y, SHIKATA, K, IIDA, M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 23-05-2006
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Brain Ischemia - epidemiology; Cerebral Infarction - classification; Cerebral Infarction - epidemiology; Cerebral Infarction - etiology; Cohort Studies; Female; Follow-Up Studies; Glucose Intolerance - epidemiology; Human viral diseases; Humans; Hypertension - epidemiology; Incidence; Infectious diseases; Intracranial Arteriosclerosis - complications; Intracranial Arteriosclerosis - epidemiology; Intracranial Embolism - complications; Intracranial Embolism - epidemiology; Japan - epidemiology; Life Tables; Male; Medical sciences; Middle Aged; Morbidity - trends; Mortality - trends; Neurology; Prevalence; Risk Factors; Smoking - epidemiology; Smoking - trends; Social Change; Suburban Population; Survival Analysis; Survival Rate; Vascular diseases and vascular malformations of the nervous system; Viral diseases; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; Japan; Vascular disease; Cerebral infarction; Nervous system diseases; Central nervous system disease; Cardiovascular disease; Japanese; Cerebrovascular disease; Cerebral disorder; Incidence
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/01.wnl.0000216132.95207.b4

There is scant information on secular trends in the incidence and survival of ischemic stroke subtypes.
The authors established three cohorts of Hisayama residents age > or =40 years in 1961 (1,618 subjects), 1974 (2,038 subjects), and 1988 (2,637 subjects). They followed up with each cohort for 12 years, comparing the incidence and survival rate of ischemic stroke subtypes. Morphologic examinations by autopsy or brain imaging was performed on most of the ischemic stroke cases in all cohorts.
The age-standardized incidence of lacunar infarction significantly declined by 59% for men and by 28% for women from the first to the second cohort. It continued to decline by 41% for men, but the decline decelerated for women between the second and third cohort. The age-standardized incidence of atherothrombotic infarction tended to decline from the first to the second cohort, whereas it was sustained between the second and third cohort for both sexes. The age-standardized incidence of cardioembolic infarction was unchanged throughout the cohorts. In these cohorts, mean blood pressure levels among hypertensive subjects and the prevalence of current smoker decreased with time, though the prevalence of hypertension remained stable. The 5-year survival rate after lacunar infarction significantly improved among the cohorts, but those of atherothrombotic and cardioembolic infarction did not.
These data suggest that, in the Japanese population, the incidence of lacunar infarction steadily declined for the last 40 years. The improvement of hypertension control and decreasing prevalence of smoking might be responsible for this trend.