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Diabetes Mellitus and Risk of Stroke and Its Subtypes Among Japanese: The Japan Public Health Center Study

Background and Purpose— Although diabetes mellitus has been recognized as a risk factor for ischemic stroke, evidence is limited for ischemic stroke subtypes among Asians. Methods— A survey was conducted of a total of 13 129 men and 22 528 women aged 40 to 69 years at baseline. During the median 12.0-year follow-up, there were 526 incidences of ischemic strokes (259 lacunar infarctions, 91 large-artery occlusive, and 140 embolic infarctions). Results— The risk of ischemic stroke for both sexes was approximately 2 to 4 times higher for diabetic subjects than for those with normal glucose levels. Significant excess risks of lacunar and embolic infarction for both sexes and of large-artery occlusive infarctions for women were also observed in diabetic subjects. Diabetes mellitus was not associated with risk of intraparenchymal or subarachnoid hemorrhage for either sex. Conclusions— Diabetes mellitus is a significant risk factor for ischemic stroke and all subtypes of ischemic stroke for middle-aged Japanese.