(Stroke. 2001;32:2725.)
© 2001 American Heart Association, Inc.
Letters to the Editor |
Letters to the Editor
Re: Socioeconomic Status and Ischemic Stroke
Cleveland, Ohio
To the Editor:
Jakovljevi
et al1 find that persons with low socioeconomic status have considerable excess rates of morbidity and mortality from ischemic stroke in Finland.
Neurobiological features are suggested by the correlation of the rate of speech hesitation pauses of 1 second or more, 4.79±2.48 per min, 1.50±0.33 seconds (mean±SD) with immobility in the face of stress, the state of the circulation (angina/hypertension), and a 6-fold incidence of clinical coronary artery disease in 2 groups of normal, coronary-prone men followed prospectively for 10 years (P<0.05). This hypothesis is supported by profound effects on angina through consciously focusing attention on breathing and intervening pauses, the association of the reduction of blood pressure with longer, less-recurrent pauses (about 2 seconds), reports that the microvascular response to the onset of neural activity is delayed consistently by about 3 seconds and is linked to increased coherence of electroencephalograph gamma-band activity associated with the execution of more complex tasks,2 and increased blood flow may process glutamate during sudden increases in neuronal activation3 in order to maximize the power of intracortical processing within the gamma range of local field potentials.4
These findings give precise, objective methods with which to evaluate the effect of mental stress on the microvasculature2 and suggest interventions to "improve" the attitudes of short-term stroke survivors toward their illness, which may increase long-term survival,5 decrease the burden of ischemic stroke to the society and thus constitute an important public health improvement,1 and enhance performance of patients and their spouses, whose psychological well-being is impacted more by the patient’s coping capacity than by the objective state of disability.2,6
References
1.
Jakovljevi; D, Sarti C, Sivenius J, Torppa J, Mähönen M, Immonen-Räihä P, Kaarsalo E, Alhainen K, Kuulasmaa K, Tuomilehto J, Puska P, Salomaa V. Socioeconomic status and ischemic stroke: the FINMONICA Stroke Register. Stroke. 2001; 32: 1492–1498.
2.
Friedman EH. Socioeconomic inequalities in cardiovascular disease mortality. Eur Heart J. 2001; 22: 715.Letter.
3. Raichle ME. Bold insights. Nature. 2001; 412: 128–130.[Medline] [Order article via Infotrieve]
4. Logothetis NK, Pauls J, Augath M, Trinath T, Oeltermann A. Neurophysiological investigation of the basis of the fMRI signal. Nature. 2001; 412: 150–157.[Medline] [Order article via Infotrieve]
5.
Lewis SC, Dennis MS, O’Rourke SJ, Sharpe M. Negative attitudes among short-term stroke survivors predict worse long-term survival. Stroke. 2001; 32: 1640–1645.
6.
Forsberg-Warleby G, Moller A, Blomstrand C. Spouses of first-ever stroke patients: psychological well-being in the first phase after stroke. Stroke. 2001; 32: 1646–1651.
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