Ten year recurrence after first ever stroke in a Japanese community: the Hisayama study.
BACKGROUND
Very few population based cohort studies have focused on the long term recurrence of stroke.


OBJECTIVE
To examine 10 year cumulative recurrence rates for stroke in a Japanese cohort according to pathological type and clinical subtype of brain infarction.


METHODS
During a 32 year follow up of 1621 subjects >/=40 years of age, 410 developed first ever stroke. These were followed up prospectively for 10 years after stroke onset.


RESULTS
During follow up, 108 (26%) experienced recurrent stroke. The cumulative recurrence rates were 35.3% at five years and 51.3% at 10 years. The 10 year recurrence rates of subarachnoid haemorrhage (SAH), brain haemorrhage, and brain infarction were 70.0%, 55.6%, and 49.7%, respectively; the difference between SAH and brain infarction was significant (p = 0.004). Most recurrent episodes after SAH or brain haemorrhage happened within a year after the index stroke, whereas recurrence of brain infarction increased consistently throughout the observation period. Cardioembolic stroke had a higher recurrence rate (75.2%) than lacunar infarction (46.8%) (p = 0.049). The 10 year risk of stroke recurrence increased with age after lacunar or atherothrombotic brain infarction, but not after the other types or subtypes. After atherothrombotic brain infarction, cardioembolic stroke, or SAH, the type and subtype of most recurrent strokes were the same as for the index stroke, but recurrence after lacunar infarction or brain haemorrhage showed divergent patterns.


CONCLUSIONS
Japanese people have higher recurrence rates of stroke than other populations. Recurrence rate after a first brain infarct increases consistently through the next 10 years.
Hata
J
J
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan. junhata@intmed2.med.kyushu-u.ac.jp
Tanizaki
Y
Y
Kiyohara
Y
Y
Kato
I
I
Kubo
M
M
Tanaka
K
K
Okubo
K
K
Nakamura
H
H
Oishi
Y
Y
Ibayashi
S
S
Iida
M
M
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000208:ethnology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D020521:Stroke / Q000208:ethnology / Q000473:pathology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
Stroke. 1998 Dec;29(12):2491-500
9836757
J Neurol Neurosurg Psychiatry. 1998 Jun;64(6):771-6
9647308
Stroke. 2000 May;31(5):1062-8
10797166
Stroke. 2000 Nov;31(11):2616-22
11062284
Stroke. 2001 Dec 1;32(12):2735-40
11739965
Stroke. 2003 Jun;34(6):1457-63
12750544
Stroke. 2003 Oct;34(10):2349-54
12958323
Stroke. 2003 Oct;34(10):2343-7
14500930
Stroke. 1982 May-Jun;13(3):290-5
7080120
Neurology. 1982 Aug;32(8):871-6
7048128
Neurology. 1989 Sep;39(9):1246-50
2671793
Stroke. 1991 Feb;22(2):155-61
2003278
Lancet. 1991 Jun 22;337(8756):1521-6
1675378
Stroke. 1992 Mar;23(3):325-7
1542890
Stroke. 1993 Jan;24(1):35-41
7678184
J Neurol Sci. 1993 Feb;114(2):128-37
8445393
Stroke. 1993 Nov;24(11):1681-5
8236343
Stroke. 1994 Feb;25(2):333-7
8303740
Neurology. 1994 Apr;44(4):626-34
8164815
Stroke. 1997 Jul;28(7):1507-17
9227708
Neurology. 1998 Jan;50(1):208-16
9443482
Prog Brain Res. 1966;21:64-89
5917289