title: Subsequent vascular events after ischemic stroke: the Japan Statin Treatment Against Recurrent Stroke-Longitudinal.
abstract: BACKGROUND
  We undertook a multicenter cohort observational study to investigate the frequency and type of subsequent vascular events after an ischemic stroke and to compare the rates of vascular events between patients with and without hyperlipidemia.
  
  
  METHODS
  This nationwide study was conducted in 19 hospitals participating in the Japan Standard Stroke Registry Study. We enrolled ischemic stroke patients, including those with a transient ischemic attack, who had not experienced any vascular events before enrollment after their ischemic stroke events. Each subject was observed prospectively from September 1, 2003, to October 1, 2005, or until a primary end point or death. Primary end points included subsequent fatal or nonfatal vascular events: stroke, angina pectoris, acute myocardial infarction, aortic aneurysm, or arteriosclerosis obliterans.
  
  
  RESULTS
  A total of 449 patients (mean age, 67.6 years; 64.8% men) were enrolled in this study. Of the 41 vascular events observed during follow-up, 40 were stroke. The median observation period was 568 days. We found that patients with hyperlipidemia had a significantly higher rate of vascular events compared with those without hyperlipidemia according to the Kaplan-Meier method and the log-rank test (P = .013). Hyperlipidemia significantly increased the risk of vascular events (hazard ratio, 2.169 [1.125-4.312]; P = .021) according to the Cox proportional hazard model after adjusting for confounding factors (age, sex, days from ischemic stroke until enrollment, smoking habits, and daily drinking habits).
  
  
  CONCLUSIONS
  This study demonstrated that stroke was the most common subsequent vascular event after ischemic stroke; the study also indicated that hyperlipidemia could be a risk factor for subsequent vascular events after ischemic stroke.
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Nomura
authors.affiliation: Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Suzuki
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Inoue
authors.affiliation: Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan.
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.affiliation: Department of Neurology, Hematology and Rheumatology, School of Medicine, Shimane University, Izumo, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Neurology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Manabe
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Yokota
authors.affiliation: Department of Neurology, Ohda Municipal Hospital, Ohda, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Okada
authors.affiliation: Department of Neurosurgery, Kanto Medical Center NTT EC, Tokyo, Japan.
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Nishihara
authors.affiliation: Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Neurology, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Noda
authors.affiliation: Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Setsuro
authors.initials: S
authors.lastname: Ibayashi
authors.affiliation: Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Takagi
authors.affiliation: Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
authors.affiliation: Second Department of Internal Medicine, Fukui University, Fukui, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kuriyama
authors.affiliation: Department of Neurology, Dokkyo Medical University, Mibu, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan. Electronic address: nhosomi@hiroshima-u.ac.jp.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Hosomi
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
authors.affiliation: Department of Neurology, Hematology and Rheumatology, School of Medicine, Shimane University, Izumo, Japan.
authors.forename: Shotai
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy*; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Ischemic stroke; diabetes mellitus; hyperlipidemia; hypertension; statin