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Background and aims We aimed to investigate secular trends in the incidence, risk factors, and prognosis of transient ischemic attack (TIA) in a general Japanese population. Methods Two cohorts consisting of stroke-free Japanese individuals aged ≥40 years in 1961 (n = 1621) and 1988 (n = 2646) were followed up for 24 years. The associations of potential risk factors with the development of TIA were estimated by a Cox proportional hazards model. The influence of TIA on the risk of total stroke over the subsequent 10 years was compared between the sub-cohorts of subjects with TIA and age- and sex-matched control subjects from each cohort. Results During follow-up, 28 subjects in the 1961 cohort and 34 in the 1988 cohort experienced TIA. The age-standardized incidence of TIA was significantly lower in the 1988 cohort than the 1961 cohort (0.66 vs. 1.01 per 1000 person-years, p = 0.02). While elevated systolic blood pressure was significantly associated with the risk of TIA in both cohorts, glucose intolerance and higher serum cholesterol levels were associated with TIA risk only in the 1988 cohort. The subjects experiencing TIA had approximately 7–8-fold higher risks for the 10-year incidence of total and ischemic strokes compared with the corresponding control subjects without TIA both in the 1961 and 1988 sub-cohorts, and the relative risks were not significantly different between sub-cohorts. Conclusions Our results suggest that the incidence of TIA decreased during the past half century, probably due to the spread of antihypertensive treatments in the general Japanese population. [ABSTRACT FROM AUTHOR]

Objectives The association between hematocrit levels and the risk of cardiovascular disease (CVD) has been reported inconsistently. We aimed to investigate the association of hematocrit levels with the development of stroke and coronary heart disease (CHD) in a general Japanese population. Methods A total of 2585 community-dwelling Japanese individuals aged 40 years or older in 1988 were followed up for 19 years. These subjects were divided into four groups according to the sex-specific quartiles of hematocrit at baseline. Results During the follow-up, 301 subjects developed stroke (210 ischemic and 91 hemorrhagic) and 187 developed CHD. The risk of ischemic stroke was higher in both the lowest (Q1: men, ≤44.7%; women, ≤39.3%) and the highest (Q4: men, ≥49.7%; women, ≥43.8%) quartiles than in the third quartile (Q3: men, 47.1%–49.6%; women, 41.7%–43.7%) used as a reference (multivariable-adjusted hazard ratios [95% confidence intervals]: Q1, 1.55 [0.99–2.43]; Q2, 1.44 [0.93–2.23]; Q3, 1.00; and Q4, 1.62 [1.06–2.50]; P = 0.86 for trend). In contrast, hematocrit levels and the risk of hemorrhagic stroke showed a linear inverse association (Q1, 1.91 [1.03–3.54]; Q2, 1.26 [0.68–2.34]; Q3, 1.00; and Q4, 0.81 [0.41–1.61]; P = 0.009 for trend). The risk of CHD increased significantly in Q4 (Q1, 1.13 [0.71–1.80]; Q2, 1.08 [0.69–1.71]; Q3, 1.00; and Q4, 1.60 [1.04–2.46]; P = 0.13 for trend). Conclusions Our findings suggest that both elevated and decreased hematocrit levels are associated with an increased risk of CVD, but the influence of hematocrit is different among subtypes of CVD. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: It has not been fully determined whether non-high-density lipoprotein cholesterol (non-HDLC) levels are involved in vascular events, especially stroke, in general Asian populations. We evaluated the association between non-HDLC levels and the risk of type-specific cardiovascular disease in a prospective cohort study in Japan. Methods: A total of 2452 community-dwelling Japanese subjects aged ≥40 years were followed prospectively for 24 years. Results: The age- and sex-adjusted incidence of coronary heart diseases (CHD) significantly increased with elevating non-HDLC levels (P for trend < 0.001), but no such association was observed for ischemic and hemorrhagic strokes. With regard to ischemic stroke subtypes, the age- and sex-adjusted incidence of lacunar infarction significantly increased with elevating non-HDLC levels (P for trend < 0.01), and such tendency was seen for atherothrombotic infarction (P for trend = 0.098), while a significant inverse association was observed for cardioembolic infarction (P for trend = 0.007). After adjustment for confounders, namely, age, sex, diabetes, body mass index, systolic blood pressure, electrocardiogram abnormalities, current drinking, current smoking, and regular exercise, the associations remained significant for CHD [adjusted hazard ratio (HR) for a 1 standard deviation of non-HDLC concentrations = 1.17, 95% confidence interval (CI) = 1.02 to 1.35], atherothrombotic infarction (adjusted HR = 1.39, 95% CI = 1.09 to 1.79), and cardioembolic infarction (adjusted HR = 0.64, 95% CI = 0.47 to 0.85). Conclusions: Our findings suggest that elevated non-HDLC levels are a significant risk factor for the development of atherothrombotic infarction as well as CHD but reduce the risk of cardioembolic infarction in the general Japanese population. [Copyright &y& Elsevier]

Abstract: Objective: We examined the association between the ratio of serum eicosapentaenoic acid to arachidonic acid (EPA/AA) or the docosahexaenoic acid (DHA)/AA and the development of cardiovascular disease in a general Japanese population. Methods: A total of 3103 community-dwelling Japanese individuals aged ≥40 years were followed up for an average of 5.1 years. Serum EPA/AA ratios were categorized into quartiles. The risk estimates were computed using a Cox proportional hazards model. Results: During the follow-up period, 127 subjects experienced cardiovascular events. Age- and sex-adjusted incidence rates of cardiovascular disease increased with lower serum EPA/AA ratios in individuals with high-sensitivity C-reactive protein (HS-CRP) of ≥1.0 mg/L (p for trend = 0.006), whereas no clear association was observed in those with HS-CRP of <1.0 mg/L (p for trend = 0.27). The multivariable-adjusted risk of cardiovascular disease increased significantly, by 1.52 times (95% confidence interval 1.12–2.04) per 0.20 decrement in serum EPA/AA ratio in subjects with HS-CRP of ≥1.0 mg/L. A lower serum EPA/AA ratio was significantly associated with an increased risk of coronary heart disease, but there was no evidence of an association with stroke. The magnitude of the influence of the serum EPA/AA ratio on the cardiovascular risk increased significantly with elevating HS-CRP levels taken as a continuous variable (p for heterogeneity = 0.007). However, no such association was observed for DHA/AA ratio. Conclusion: Our findings suggest that a lower serum EPA/AA ratio is associated with a greater risk of cardiovascular disease, especially coronary heart disease, among subjects with higher HS-CRP levels in the general Japanese population. [Copyright &y& Elsevier]