Is the Stroke Belt Worn From Childhood?

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 …