title: Risk of hospitalized stroke in men enrolled in the Honolulu Heart Program and the Framingham Study: A comparison of incidence and risk factor effects.
abstract: OBJECTIVE
  Risk of death due to stroke in Japan is more than double the risk in the United States. It remains unknown why some ethnic groups are more prone to stroke than others. Our purpose was to compare the 20-year incidence of hospitalized stroke between Japanese-American men in the Honolulu Heart Program and white men in the Framingham Study.
  
  
  METHODS
  This was a 20-year follow-up study beginning around 1965, a population-based study on the island of Oahu, Hawaii, and in Framingham, Mass. Participants were 7589 men in Honolulu and 1216 men in Framingham without prevalent coronary heart disease and stroke. Subjects were 45 to 68 years old when follow-up began. Main outcome measures were incident thromboembolic and hemorrhagic stroke.
  
  
  RESULTS
  Framingham men had a 40% excess of thromboembolic stroke compared with Honolulu men after adjustment for age and other risk factors (62/1000 versus 45/1000, respectively, P<0.001), whereas incidence of hemorrhagic stroke was nearly identical (14.8/1000). In both cohorts, each stroke type was consistently elevated in the presence of hypertension and cigarette smoking. Diabetes and body mass index increased the risk of thromboembolic stroke in both samples, and diabetes increased the risk of hemorrhagic events in Framingham. Alcohol intake and low total cholesterol were associated with hemorrhagic events in Honolulu but not in Framingham. Despite occasional differences in risk factor effects, none were significantly different between cohorts.
  
  
  CONCLUSIONS
  The incidence of thromboembolic stroke requiring hospitalization is markedly less in Honolulu than in Framingham. The difference in stroke incidence rates observed cannot be explained by the traditional risk factors. Further studies are needed to identify factors that protect Japanese-American men in Honolulu from stroke.
authors.affiliation: Division of Clinical Epidemiology, John A. Burns School of Medicine, University of Hawaii at Manoa, USA. beatriz@phri.hawaii-health.com
authors.forename: Beatriz L
authors.initials: BL
authors.lastname: Rodriguez
authors.forename: Ralph
authors.initials: R
authors.lastname: D'Agostino
authors.forename: Robert D
authors.initials: RD
authors.lastname: Abbott
authors.forename: Abraham
authors.initials: A
authors.lastname: Kagan
authors.forename: Cecil M
authors.initials: CM
authors.lastname: Burchfiel
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yano
authors.forename: G Webster
authors.initials: GW
authors.lastname: Ross
authors.forename: Halit
authors.initials: H
authors.lastname: Silbershatz
authors.forename: Millicent W
authors.initials: MW
authors.lastname: Higgins
authors.forename: Jordan
authors.initials: J
authors.lastname: Popper
authors.forename: Philip A
authors.initials: PA
authors.lastname: Wolf
authors.forename: J David
authors.initials: JD
authors.lastname: Curb
mesh_terms: D000368:Aged; D001213:Asian; D002543:Cerebral Hemorrhage / Q000208:ethnology; D005500:Follow-Up Studies; D006254:Hawaii / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007564:Japan / Q000208:ethnology; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology*; D013923:Thromboembolism / Q000208:ethnology; D044465:White People