From the Department of Veterans Affairs and Washington University School
of Medicine, St Louis, Mo (H.M.P.), and the National Heart, Lung, and Blood
Institute, Bethesda, Md (E.J.R.).
Abstract—A workshop to describe and
then seek possible causes for the increased stroke mortality in the
southeastern United States briefly considered 30 suspected correlates
and discussed in more detail the 10 thought to be most likely. Recent
age-adjusted stroke mortality rates in adults from industrialized
countries reveal marked geographic differences. Age-adjusted statewide
stroke mortality rates also differ, and they are higher in the
Southeast than elsewhere in the United States. For five southeastern
coastal states in the heart of the "Stroke Belt," excess stroke
mortality has been present at least since 1930. In a 20-year
follow-up of 10 000 veterans, the Stroke Belt had a 25% increase in
all-cause mortality and congestive heart failure. A potential cause of
increased fatal stroke included hypertension, which was more frequent
in the Stroke Belt. No consistent patterns of lifestyle
differences or of differences in potassium or calcium intake seemed to
explain the higher rates of fatal strokes in the Stroke Belt; however,
detailed investigations of smaller populations in localized areas seem
warranted. Some data suggest a relationship between socioeconomic
status and the Stroke Belt effect. Other differences in the Southeast
that could explain, at least partially, the Stroke Belt effect include
presence of soft water throughout most of the area, decreased
antioxidant intake, and differences in the use of medical care and in
the response to antihypertensive drugs. On the basis of available
information, the three most likely explanations or partial explanations
for the Stroke Belt are increased levels of blood pressure, localized
differences in socioeconomic status, and toxic environmental factor(s).
Two major recommendations were made: (1) to encourage both patient and
caregiver to use all currently available means of decreasing morbidity
and mortality by controlling blood pressures at or below normal levels
and by reducing other risk factors and (2) to seek precise information
about relationships of identified possible causes of increased
morbidity and mortality in the Stroke Belt.
© 1998 American Heart Association, Inc.
Scientific Contributions
Conference Report on Stroke Mortality in the Southeastern United States
Key Words: heart failure • lifestyle • social class • stroke
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