久山町研究からみた動脈硬化とその関連疾患

抄録

Mortality and incidence of cardiovascular diseases and their changing patterns were studied on the basis of the results from the long-term and autopsy-based prospective population survey conducted in a Japanese rural community, Hisayama since 1961, taking pathologic characteristics of atherosclerosis and its risk profile into account. Mortality from intracerebral hemorrhage and cerebral infarction recently decreased among the Hisayama population, and this is possibly due to the reduction in the incidence of intracerebral hemorrhage and cerebral infarction. Of the specific three types of cerebral infarction (lacunar infarcts, cortical infarcts and cerebral embolism), lacunar infarcts (in the perforating arterial areas) which were most frequent among the Hisayama population, only decreased in the recent study cohort. A pathologic study revealed that the detected frequency of fibrinoid necrosis on the putamen decreased in autopsy-cases from the population in 1970's compared to those in 1960's. This can be related to the decreased prevalence and improved control of hypertension in the recent population. On the other hand, subarachnoid hemorrhage more occurred especially in aged females than expected, and its incidence increased with advanced age decade. The frequency of multiple infarcts on the cortex or deep white matter increased with advanced age-decade and were thought to give a great influence on the prognosis of the aged through impairing activity of daily life and inducing vascular dementia. This involvement seemed to be associated with aging-process and its degenerative changes rather than hypertensive vascular lesions on the brain. Ischemic heart disease (IHD) including myocardial infarction did not increase among the recent population. Risk factors for IHD were, however, hypertension, high value of serum cholesterol, cigarette-smoking and obesity. Moreover serum cholesterol was more related to myocardial infarction from the recent population than that from the initial one. Since metabolic atherogenic factors such as serum lipid profiles, glucose intolerance, obesity steadily increase among the recent Hisayama residents, atherosclerosis and its related disease are highly expected to further increase in the future.