(Stroke. 2000;31:2616.)
© 2000 American Heart Association, Inc.
Original Contributions |
Incidence and Risk Factors for Subtypes of Cerebral Infarction in a General Population
The Hisayama Study
From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Correspondence to Yumihiro Tanizaki, MD, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan. E-mail yumi{at}intmed2.med.kyushu-u.ac.jp
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.
Key Words: cerebral embolism • lacunar infarction • prospective studies • risk factors • thrombosis
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