Lifetime risk (LTR) evaluates the absolute risk of developing a disease during the remainder of one’s life. It can be a useful tool, enabling the general public to easily understand their risk of stroke. No study has been performed to determine the LTR of cardiovascular disease in patients with chronic kidney disease (CKD) with or without hypertension; therefore, we performed this study in an Asian population. We followed 1525 participants (66.0% women; age 63.1 years) in the general population of Ohasama, Japan. We defined CKD as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or proteinuria. Hypertension was defined as a systolic/diastolic blood pressure ≥140/≥90 mmHg and/or the use of antihypertensive medication. We calculated the sex-specific LTR of stroke adjusted for the competing risk of death. During the mean follow-up period of 16.5 years, a first stroke occurred in 238 participants. The 10-year risk of stroke at the age of 45 years was 0.0% for men and women. The LTRs of stroke at the index age of 45 years (men/women) were 20.9%/14.5% for participants without CKD and hypertension, 34.1%/29.8% for those with CKD but not hypertension, 37.9%/27.3% for those with hypertension but not CKD, and 38.4%/36.4% for those with CKD and hypertension. The LTRs of stroke tended to be higher in younger participants than in older participants with CKD and/or hypertension. CKD contributed to the LTR of stroke, as did hypertension. The prevention of CKD and hypertension can reduce the LTR of stroke, especially in young populations.
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Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1151–210.
Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1260–344.
Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). G Ital Cardiol (Rome). 2018;19:3–73.
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.
Nakayama M, Metoki H, Terawaki H, Ohkubo T, Kikuya M, Sato T, et al. Kidney dysfunction as a risk factor for first symptomatic stroke events in a general Japanese population–the Ohasama study. Nephrol Dial Transpl. 2007;22:1910–5.
Cherng YG, Lin CS, Shih CC, Hsu YH, Yeh CC, Hu CJ, et al. Stroke risk and outcomes in patients with chronic kidney disease or end-stage renal disease: two nationwide studies. PLoS One. 2018;13:e0191155.
Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, Shiigai T, et al. Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study. Kidney Int. 2007;71:159–66.
Campese VM, Mitra N, Sandee D. Hypertension in renal parenchymal disease: why is it so resistant to treatment? Kidney Int. 2006;69:967–73.
Fortin JM, Hirota LK, Bond BE, O’Connor AM, Col NF. Identifying patient preferences for communicating risk estimates: a descriptive pilot study. BMC Med Inf Decis Mak. 2001;1:2.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.
Beiser A, D’Agostino RB Sr, Seshadri S, Sullivan LM, Wolf PA. Computing estimates of incidence, including lifetime risk: Alzheimer’s disease in the Framingham Study. The Practical Incidence Estimators (PIE) macro. Stat Med. 2000;19:1495–522.
Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2016;37:2999–3058.
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596–646.
Seshadri S, Beiser A, Kelly-Hayes M, Kase CS, Au R, Kannel WB, et al. The lifetime risk of stroke: estimates from the Framingham Study. Stroke. 2006;37:345–50.
Takahashi I, Geyer SM, Nishi N, Ohshita T, Takahashi T, Akahoshi M, et al. Lifetime risk of stroke and impact of hypertension: estimates from the adult health study in Hiroshima and Nagasaki. Hypertens Res. 2011;34:649–54.
Turin TC, Okamura T, Afzal AR, Rumana N, Watanabe M, Higashiyama A, et al. Hypertension and lifetime risk of stroke. J Hypertens. 2016;34:116–22.
Satoh M, Ohkubo T, Asayama K, Murakami Y, Sugiyama D, Yamada M, et al. Lifetime Risk of Stroke and Coronary Heart Disease Deaths According to Blood Pressure Level: EPOCH-JAPAN (Evidence for Cardiovascular Prevention From Observational Cohorts in Japan). Hypertension. 2019;73:52–9.
Wang Y, Liu J, Wang W, Wang M, Qi Y, Xie W, et al. Lifetime risk of stroke in young-aged and middle-aged Chinese population: the Chinese Multi-Provincial Cohort Study. J Hypertens. 2016;34:2434–40.
Hall YN, Hsu CY, Iribarren C, Darbinian J, McCulloch CE, Go AS. The conundrum of increased burden of end-stage renal disease in Asians. Kidney Int. 2005;68:2310–6.
Ueshima H, Sekikawa A, Miura K, Turin TC, Takashima N, Kita Y, et al. Cardiovascular disease and risk factors in Asia: a selected review. Circulation. 2008;118:2702–9.
Imai Y, Nagai K, Sakuma M, Sakuma H, Nakatsuka H, Satoh H, et al. Ambulatory blood pressure of adults in Ohasama, Japan. Hypertension. 1993;22:900–12.
Kanno A, Kikuya M, Asayama K, Satoh M, Inoue R, Hosaka M, et al. Night-time blood pressure is associated with the development of chronic kidney disease in a general population: the Ohasama Study. J Hypertens. 2013;31:2410–7.
Kanno A, Kikuya M, Ohkubo T, Hashimoto T, Satoh M, Hirose T, et al. Pre-hypertension as a significant predictor of chronic kidney disease in a general population: the Ohasama Study. Nephrol Dial Transpl. 2012;27:3218–23.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–115.
Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.
Horio M, Imai E, Yasuda Y, Watanabe T, Matsuo S. Modification of the CKD epidemiology collaboration (CKD-EPI) equation for Japanese: accuracy and use for population estimates. Am J Kidney Dis. 2010;56:32–8.
Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. Stroke. 1990;21:637–76.
Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366:321–9.
Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: effects on the cardiovascular system. Circulation. 2007;116:85–97.
Bugnicourt JM, Chillon JM, Massy ZA, Canaple S, Lamy C, Deramond H, et al. High prevalence of intracranial artery calcification in stroke patients with CKD: a retrospective study. Clin J Am Soc Nephrol. 2009;4:284–90.
Muntner P, Hamm LL, Kusek JW, Chen J, Whelton PK, He J. The prevalence of nontraditional risk factors for coronary heart disease in patients with chronic kidney disease. Ann Intern Med. 2004;140:9–17.
Madore F. Uremia-related metabolic cardiac risk factors in chronic kidney disease. Semin Dial. 2003;16:148–56.
Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63:713–35.
We are grateful to the residents and staff members in Ohasama and staff members of the Hanamaki City Government, Iwate Prefectural Central Hospital Attachment Ohasama Regional Clinical Center, Iwate Prefectural Stroke Registry, General Hanamaki Hospital, Teikyo University, Tohoku Medical and Pharmaceutical University, and Tohoku University for their valuable support of the Ohasama study project.
This study was supported by Grants for Scientific Research (16H05243, 16H05263, 16K09472, 16K11850, 16K15359, 17H04126, 17H06533, 17K15853, 17K19930, 18K09674, 18K09904, 18K17396, 19K19466, 19H03908, 19K10662, and 20K08612) from the Ministry of Education, Culture, Sports, Science, and Technology, Japan; a Grant-in-Aid for Young Scientists of Showa Pharmaceutical University H28-4; the Japan Arteriosclerosis Prevention Fund; Grant–in–aid from the Ministry of Health, Labor, and Welfare, Japan (H26-Junkankitou [Seisaku]-Ippan-001, H29–Junkankitou–Ippan–003 and 20FA1002); A Scheme to Revitalize Agriculture and Fisheries in Disaster Area through Deploying Highly Advanced Technology (NouEi 2-02) from the Ministry of Agriculture, Forestry and Fisheries, Japan; the internal research grants from Keio University; Advanced Comprehensive Research Grants of Teikyo University; the Academic Contributions from Pfizer Japan Inc.; scholarship donations from Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd.; research supports from Astellas Pharma Inc. and Takeda Pharmaceutical Co., Ltd.; the Health Care Science Institute Research Grant; and the Health Science Center Research Grant.
Conflict of interest
H.M., K.A., Y.I., and T.O concurrently held the position of director of the Tohoku Institute for Management of Blood Pressure, supported by Omron Healthcare Co., Ltd.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Nakayama, S., Satoh, M., Metoki, H. et al. Lifetime risk of stroke stratified by chronic kidney disease and hypertension in the general Asian population: the Ohasama study. Hypertens Res 44, 866–873 (2021). https://doi.org/10.1038/s41440-021-00635-z
- Lifetime risk
- chronic kidney disease