Stroke deaths unexplained by customary risk factors

NEW YORK (Reuters Health) - While stroke death rates are approximately 50 percent higher than average among residents of the southeastern U.S. — the so-called “stroke belt” — traditional risk factors contribute little to the higher death rates there, a national study indicates.

The national Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study included nearly 24,000 subjects age 45 years and older without a history of stroke or transient ischemic attack (a “mini stroke.”)

About half the subjects lived in the eight states comprising the stroke belt, while the others were from the other 40 contiguous states, they report in the Annals of Neurology.

Participants were examined in their homes between 2003 and 2007 to assess Framingham Stroke Risk Score, a scale comprised of nine risk factors used to predict the 10-year probability of stroke.

After consideration of age, race and sex-related factors, the predicted stroke risk was only slightly greater in the stroke belt states than elsewhere (10.7 percent vs 10.1 percent), Dr. Mary Cushman, at the University of Vermont, Burlington, and colleagues report.

However, the prevalence of diabetes was up to 5 percentage points greater in the Southeast. Thus, the authors suggest that, “Interventions to reduce geographic disparities in diabetes, including optimizing prevention, diagnosis and treatment, may hold promise for reducing geographic disparities in stroke mortality.”

Blacks had a worse risk factor profiles than whites, but the differences did not vary by geographic regions, the investigators note.

“Although components of the Framingham Stroke Risk Score may influence case fatality, other factors not addressed in our analysis, such as poverty, access to care and nontraditional risk factors also need to be considered,” the authors argue. They expect that follow-up data from the ongoing REGARDS study will provide such information.

SOURCE: Annals of Neurology, November 2008.

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