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(Stroke. 2003;34:2609.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—North, South: Changing Directions in Cardiovascular Epidemiology

Department of Epidemiology and Public Health, Queen’s University, Belfast, UK
Department of Social Medicine, University of Bristol, Bristol, UK

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Despite impressive declines in cardiovascular disease (CVD) over the last half-century, stroke and coronary heart disease (CHD) still constitute the greatest disease burden in the developed world. Moreover, there is accumulating evidence that developing countries will be faced with stroke and CHD epidemics in the relatively near future.¹ Much of our understanding of the etiology of CVD has been gained from prospective cohort studies such as the British Regional Heart Study (BRHS), and in this issue of Stroke, Morris and colleagues² supplement a previous report from this study of geographical patterns of CHD incidence³ by extending the length of follow-up and examining geographical variations in stroke. The BRHS is an ideal study for investigating the geographical inequalities in CVD. Indeed, the study was established with this aim in mind, specifically to test the hypothesis that water quality was a determinant of CVD risk, which proved not to be the case.⁴ However, despite the fact that the study generated >250 articles, mostly on the causes and consequences of CVD, it was not until 2001 (>20 years after the initiation of the study) that the definitive paper about the causes of regional variation in coronary heart disease appeared.⁵ This most recent contribution is therefore welcome. The authors found that among men the risks of both CHD and stroke were greater in the rest of Britain compared with the south of England and that this difference was substantially, although not completely, explained by adjustment for a number of adult CVD risk factors: systolic blood pressure, smoking status, physical activity, social class, and height. Had they . . . [Full Text of this Article]