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(Stroke. 2007;38:2403.)
© 2007 American Heart Association, Inc.

Editorials

Is the Stroke Belt Worn From Childhood?

Current Knowledge and Future Directions

Aiman El-Saed, MD, PhD Lewis H. Kuller, MD, DrPH

From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pa.

Correspondence to Aiman El-Saed, MD, PhD, University of Pittsburgh, Health Studies Office, 130 N. Bellefield Ave, Rm 429, Pittsburgh, PA 15213. E-mail amest30@pitt.edu

Key Words: cerebrovascular diseases • children • epidemiology • etiology • geography • risk factors • mortality

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

See related article, pages 2415–2421.

More than 4 decades ago, Borhani¹ reported excess stroke mortality risk in the southeastern states of the US, the "Stoke Belt". Since then, none of the many reasons proposed adequately explained the phonomenon.² Many studies have failed to adequately explain geographic differences in stroke risk using traditional stroke risk factors measured later in life.^3–6 There are 3 possible reasons why the traditional stroke risk factors failed to account for the higher stroke risk in the Stroke Belt states. First, the measurement of the risk factors may be inadequate. For example, higher blood pressure level, the most important single determinant of stroke risk, was measured in previous studies at only 1 or even several points in time, usually in middle aged or older adults. The integrated level of blood pressure from childhood or young adulthood to older ages and their adverse effects on vascular disease may be a more important determinant. Second, previous studies typically did not take into account the differential effects of treatment of the risk factors, not only including the likelihood that individuals are placed on various therapies to lower blood pressure or other risk factors but also, most important, adherence to such therapies and reduction of these risk factors. Third, there may be other still unidentified risk factors more prevalent in the southeastern states that make them carry this high risk of stroke mortality to their residents.

Supporting the concept of duration of exposure, we have previously reported in older individuals . . . [Full Text of this Article]

Related Article:

Is the ‘Stroke Belt’ Worn From Childhood?: Risk of First Stroke and State of Residence in Childhood and Adulthood

M. Maria Glymour, Mauricio Avendaño, and Lisa F. Berkman
Stroke 2007 38: 2415-2421. [Abstract] [Full Text] [PDF]

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