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      Incidence of Total Stroke, Stroke Subtypes, and Myocardial Infarction in the Japanese Population: The JMS Cohort Study

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          Abstract

          Background

          Previous reports indicated that the incidence rate of stroke was higher in Japan than in Western countries, but the converse was true in the case of myocardial infarction (MI). However, few population-based studies on the incidence rates of stroke and MI have been conducted in Japan.

          Methods

          The Jichi Medical School (JMS) Cohort Study is a multicenter population-based cohort study that was conducted in 12 districts in Japan. Baseline data were collected between April 1992 and July 1995. We examined samples from 4,869 men and 7,519 women, whose mean ages were 55.2 and 55.3 years, respectively. The incidence of stroke, stroke subtypes, and MI were monitored.

          Results

          The mean follow-up duration was 10.7 years. A total of 229 strokes and 64 MIs occurred in men, and 221 strokes and 28 MIs occurred in women. The age-adjusted incidence rates (per 100,000 person-years) of stroke were 332 and 221 and those of MI were 84 and 31 in men and women, respectively. In the case of both sexes, the incidence rates of stroke and MI were the highest in the group of subjects aged > 70 years.

          Conclusion

          We reported current data on the incidence rates of stroke and MI in Japan. The incidence rate of stroke remains high, considerably higher than that of MI, in both men and women. The incidence rates of both stroke and MI were higher in men than in women.

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          The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators.

          H Tunstall-Pedoe (1988)
          A World Health Organization Working Group has developed a major international collaborative study with the objective of measuring over 10 years, and in many different populations, the trends in, and determinants of, cardiovascular disease. Specifically the programme focuses on trends in event rates for validated fatal and non-fatal coronary heart attacks and strokes, and on trends in cardiovascular risk factors (blood pressure, cigarette smoking and serum cholesterol) in men and women aged 25-64 in the same defined communities. By this means it is hoped both to measure changes in cardiovascular mortality and to see how far they are explained; on the one hand by changes in incidence mediated by risk factor levels; and on the other by changes in case-fatality rates, related to medical care. Population centres need to be large and numerous; to reliably establish 10-year trends in event rates within a centre 200 or more fatal events in men per year are needed, while for the collaborative study a multiplicity of internally homogeneous centres showing differing trends will provide the best test of the hypotheses. Forty-one MONICA Collaborating Centres, using a standardized protocol, are studying 118 Reporting Units (subpopulations) with a total population aged 25-64 (both sexes) of about 15 million.
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            Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease.

            P Amouyel, E Ruokokoski, H Tolonen … (1999)
            The WHO MONICA (monitoring trends and determinants in cardiovascular disease) Project monitored, from the early 1980s, trends over 10 years in coronary heart disease (CHD) across 37 populations in 21 countries. We aimed to validate trends in mortality, partitioning responsibility between changing coronary-event rates and changing survival. Registers identified non-fatal definite myocardial infarction and definite, possible, or unclassifiable coronary deaths in men and women aged 35-64 years, followed up for 28 days in or out of hospital. We calculated rates from population denominators to estimate trends in age-standardised rates and case fatality (percentage of 28-day fatalities=[100-survival percentage]). During 371 population-years, 166,000 events were registered. Official CHD mortality rates, based on death certification, fell (annual changes: men -4.0% [range -10.8 to 3.2]; women -4.0% [-12.7 to 3.0]). By MONICA criteria, CHD mortality rates were higher, but fell less (-2.7% [-8.0 to 4.2] and -2.1% [-8.5 to 4.1]). Changes in non-fatal rates were smaller (-2.1%, [-6.9 to 2.8] and -0.8% [-9.8 to 6.8]). MONICA coronary-event rates (fatal and non-fatal combined) fell more (-2.1% [-6.5 to 2.8] and -1.4% [-6.7 to 2.8]) than case fatality (-0.6% [-4.2 to 3.1] and -0.8% [-4.8 to 2.9]). Contribution to changing CHD mortality varied, but in populations in which mortality decreased, coronary-event rates contributed two thirds and case fatality one third. Over the decade studied, the 37 populations in the WHO MONICA Project showed substantial contributions from changes in survival, but the major determinant of decline in CHD mortality is whatever drives changing coronary-event rates.
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              Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort.

              Andrew P McGovern, E Shahar, A-G Howard … (1999)
              Although stroke mortality rates in the United States are well documented, assessment of incidence rates and case fatality are less well studied. A cohort of 15 792 men and women aged 45 to 64 years from a population sample of households in 4 US communities was followed from 1987 to 1995, an average of 7. 2 years. Incident strokes were identified through annual phone contacts and hospital record searching and were then validated. Of the 267 incident definite or probable strokes, 83% (n=221) were categorized as ischemic strokes, 10% (n=27) were intracerebral hemorrhages, and 7% (n=19) were subarachnoid hemorrhages. The age-adjusted incidence rate (per 1000 person-years) of total strokes was highest among black men (4.44), followed by black women (3.10), white men (1.78), and white women (1.24). The black versus white age-adjusted rate ratio (RR) for ischemic stroke was 2.41 (95% CI, 1.85 to 3.15), which was attenuated to 1.38 (95% CI, 1.01 to 1.89) after adjustment for baseline hypertension, diabetes, education level, smoking status, and prevalent coronary heart disease. There was a tendency for the adjusted case fatality rates to be higher among blacks and men, although none of the case fatality comparisons across sex or race was statistically significant. After accounting for established baseline risk factors, blacks still had a 38% greater risk of incident ischemic stroke compared with whites. Identification of new individual and community-level risk factors accounting for the elevated incidence of stroke requires further investigation and incorporation into intervention planning.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Epidemiol
                Journal ID (iso-abbrev): J Epidemiol
                Journal ID (publisher-id): JE
                Title: Journal of Epidemiology
                Publisher: Japan Epidemiological Association
                ISSN (Print): 0917-5040
                ISSN (Electronic): 1349-9092
                Publication date (Electronic): 7 August 2008
                Publication date (Electronic preprint): 7 July 2008
                Publication date Collection: 2008
                Volume: 18
                Issue: 4
                Pages: 144-150
                Affiliations
                [1 ]Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University
                [2 ]School of Health and Social Services, Saitama Prefectural University
                [3 ]Community Medicine Education Center, Japan Association for Development of Community Medicine
                [4 ]Department of Public Health, Jichi Medical University
                [5 ]University of Occupational and Environmental Health, Japan
                Author notes

                Address for correspondence: Shizukiyo Ishikawa, Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan. (E-mail: i-shizu@ 123456jichi.ac.jp )

                Article
                Publisher ID: JE2007438
                DOI: 10.2188/jea.JE2007438
                PMC ID: 4771583
                PubMed ID: 18603825
                SO-VID: befa638c-ac35-499a-a32b-ad71325057c5
                Copyright © © 2008 Japan Epidemiological Association.
                License:

                This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 7 November 2007
                Date accepted : 4 February 2008
                Categories
                Subject: Original Article

                Keywords: incidence,stroke,myocardial infarction,cohort studies,asian continental ancestry group
                Data availability:
                Keywords: incidence, stroke, myocardial infarction, cohort studies, asian continental ancestry group

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