title: Diabetes and lifetime risk of stroke and subtypes in an urban middle-aged population.
abstract: OBJECTIVE
  Lifetime risk (LTR) is defined as the cumulative probability of developing a disease in one's remaining lifetime from a given index age. The impact of diabetes on the LTR of stroke events in Asians, where stroke incidence is higher than for Westerners, has not been estimated yet. These estimates can be useful for diabetes knowledge translation activities.
  
  
  METHODS
  All participants who were stroke-free at baseline in the Suita Study, a cohort study of cardiovascular diseases in Japan, were included in the study sample. Age, in years, was used as the time-scale. Age-specific incidence rates were calculated using the person-years method within five-year bands. We estimated the sex- and index-age-specific LTR of first-ever stroke accounting for the competing risk of death.
  
  
  RESULTS
  In this cohort study, we followed 5515 participants from 1989 to 2007 for 71,374.23 person-years. At age 40, the LTRs, adjusted for competing risk of death, for all strokes were 15.98% for men without diabetes and 26.64% for men with diabetes. The LTR for stroke was 10.66% higher for men with diabetes than men without diabetes. For women of same index age, the LTR of stroke was 17.29% and 30.72% with diabetes and without diabetes, respectively. The difference in LTR between persons with diabetes and without diabetes was 13.43%. This increased LTR of strokes for persons with diabetes was observed among both men and women across all index ages. Similar results were observed for cerebral infarction stroke subtype.
  
  
  CONCLUSIONS
  In this urban community-based population we observed that diabetes has a significant effect on the residual LTR of stroke for both men and women of middle age. This knowledge can be used to inform public health education and planning.
authors.affiliation: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: turin.chowdhury@ucalgary.ca.
authors.forename: Tanvir Chowdhury
authors.initials: TC
authors.lastname: Turin
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.affiliation: Sleep Center, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Nahid
authors.initials: N
authors.lastname: Rumana
authors.affiliation: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Arfan Raheen
authors.initials: AR
authors.lastname: Afzal
authors.affiliation: Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Higashiyama
authors.affiliation: Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Yoko M
authors.initials: YM
authors.lastname: Nakao
authors.affiliation: Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Michikazu
authors.initials: M
authors.lastname: Nakai
authors.affiliation: Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Misa
authors.initials: M
authors.lastname: Takegami
authors.affiliation: Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan; Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kokubo
authors.affiliation: Research Institute of Strategy for Prevention, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
authors.affiliation: Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan; Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyamoto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology / Q000208:ethnology; D002544:Cerebral Infarction / Q000150:complications / Q000453:epidemiology / Q000208:ethnology; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000453:epidemiology / Q000208:ethnology; D014504:Urban Health / Q000208:ethnology
keywords: Cohort; Diabetes; Japan; Lifetime risk; Stroke