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. 2024 Mar 1;31(3):259-272.
doi: 10.5551/jat.64018. Epub 2023 Sep 2.

Prediction of the 4-Year Incidence Risk of Ischemic Stroke in Healthy Japanese Adults: The Fukushima Health Database

Enbo Ma  1   2 , Tetsuya Ohira  1   2   3 , Makoto Miyazaki  1   3 , Maiko Fukasawa  1 , Masayo Yoshimoto  1 , Tomonori Suzuki  1   4 , Ayako Furuyama  1 , Mariko Kataoka  1   2 , Seiji Yasumura  1   3   5 , Mitsuaki Hosoya  1   3   6
Affiliations

Prediction of the 4-Year Incidence Risk of Ischemic Stroke in Healthy Japanese Adults: The Fukushima Health Database

Enbo Ma et al. J Atheroscler Thromb. .

Abstract

Aim: Estimating the risk of developing ischemic stroke (IS) may assist health professionals in motivating individuals to modify their risk behavior.

Methods: A predictive model was derived from 178,186 participants from Fukushima Health Database, aged 40-74 years, who attended the health checkup in 2014 and completed at least one annual health checkup by 2018 (Cohort I). Cox proportional hazard regression model was used to build a 4-year prediction model, thus the risk scores were based on the regression coefficients. External validation for the risk scores was conducted in another cohort of 46,099 participants following between 2015 and 2019 (Cohort II).

Results: The 4-year cumulated incidence rate of IS was 179.80/100,000 person-years in Cohort I. The predictive model included age, sex, blood pressure, hypertension treatment, diabetes, low- and high-density lipoprotein cholesterol, smoking, walking pace, and body weight change of 3 kg within one year. Risk scores were interpreted based on the Cohort I predictive model function. The Harrell's C-statistics of the discrimination ability of the risk score model (95% confidence interval) was 0.744 (0.729-0.759) in Cohort I and 0.770 (0.743-0.797) in Cohort II. The overall agreement of the risk score probability of IS incidence for the observed/expected case ratio and 95% CI was 0.98 (0.92-1.05) in Cohort I and 1.08 (0.95-1.22) in Cohort II.

Conclusions: The 4-year risk prediction model revealed a good performance for IS incidence, and risk scores could be used to estimate individual incidence risk of IS. Updated models with additional confirmed risk variables may be needed.

Keywords: External validation; Incidence risk; Ischemic stroke; Point-based score; Prediction model.

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Conflict of interest statement

All authors declare no conflict of interest.

Figures

Fig.1.
Fig.1.
Data flow for the predictive models’ derivation and validation in the two cohorts, respectively, using the Fukushima Health Database data, 2014 -2019
Fig.2. Calibration plots of the risk scores and observed 4-year risk probability of ischemic stroke incidence in Cohort I
Fig.2. Calibration plots of the risk scores and observed 4-year risk probability of ischemic stroke incidence in Cohort I
The ratio (95% confidence interval) of the observed and predicted event was 0.98 (0.92-1.05), P=0.592.
Fig.3. Four-year incidence risk scores for developing ischemic stroke, using the Fukushima Health Database data, 2014-2019
Fig.3. Four-year incidence risk scores for developing ischemic stroke, using the Fukushima Health Database data, 2014-2019
Abbreviation: DBP, diastolic blood pressure; SBP, systolic blood pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol. §Normal (SBP ＜120 and DBP ＜80 mmHg [without antihypertensive medication]); High-normal (SBP ＜130 and DBP ＜80 mmHg [without antihypertensive medication]); Elevated (SBP ＜140 or DBP ＜90 mmHg [without antihypertensive medication]); Hypertension (SBP ≥140 or DBP ≥ 90 mmHg [or using antihypertensive medication]).
Fig.4. Calibration plots based on risk scores and observed 4-year risk probability of ischemic stroke incidence in Cohort II
Fig.4. Calibration plots based on risk scores and observed 4-year risk probability of ischemic stroke incidence in Cohort II
The ratio (95% confidence interval) of the observed and predicted event was 1.08 (0.95-1.22), P=0.222.
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References

    1. Nagai M, Ohira T, Takahashi H, Nakano H, Sakai A, Hashimoto S, Yasumura S, Abe M and Fukushima Health Management S: Impact of evacuation onstrends in the prevalence, treatment, and control of hypertension before and after a disaster. J Hypertens, 2018; 36: 924-932 - PubMed
    1. Ohira T, Nakano H, Nagai M, Yumiya Y, Zhang W, Uemura M, Sakai A, Hashimoto S and Fukushima Health Management Survey G: Changes in Cardiovascular Risk Factors After the Great East Japan Earthquake. Asia Pac J Public Health, 2017; 29: 47S-55S - PubMed
    1. Takahashi S, Nakamura M, Yonekura Y, Tanno K, Sakata K, Ogawa A and Kobayashi S: Association between relocation and changes in cardiometabolic risk factors: a longitudinal study in tsunami survivors of the 2011 Great East Japan Earthquake. BMJ Open, 2016; 6: e011291 - PMC - PubMed
    1. Ohira T, Hosoya M, Yasumura S, Satoh H, Suzuki H, Sakai A, Ohtsuru A, Kawasaki Y, Takahashi A, Ozasa K, Kobashi G, Hashimoto S, Kamiya K, Yamashita S and Abe M: Evacuation and Risk of Hypertension After the Great East Japan Earthquake: The Fukushima Health Management Survey. Hypertension, 2016; 68: 558-564 - PubMed
    1. Ohira T, Hosoya M, Yasumura S, Satoh H, Suzuki H, Sakai A, Ohtsuru A, Kawasaki Y, Takahashi A, Ozasa K, Kobashi G, Kamiya K, Yamashita S and Abe M: Effect of Evacuation on Body Weight After the Great East Japan Earthquake. Am J Prev Med, 2016; 50: 553-560 - PubMed