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Background and Purpose— Stroke is a leading cause of death and disability in the US. There is limited data on geographic variations in stroke incidence among older US populations who experience the majority of stroke burden. The purpose of this study was to compare stroke incidence and mortality rates in 4 US communities. Methods— Participants in the Cardiovascular Health Study (CHS) who had no history of stroke at baseline (n=5639) were followed for 10 or 7 years in predominantly white (n=5002) and black (n=637) participants, respectively. Incident stroke was validated by a stroke adjudication committee after ascertainment at annual visits, interim telephone contacts, and review of Medicare hospitalization data. Results— The 2000 US population age and sex standardized total stroke incidence rate for all CHS participants was 17.7 per 1000 person-years (95% CI: 15.9, 19.5). The rate was significantly lower in Allegheny County, Pennsylvania 9.6/1000 person-years (95% CI: 7.7, 11.5) than Forsyth County, North Carolina 19.2/1000 person-years (95% CI: 15.6, 22.8), Sacramento County, California 20.7/1000 person-years (95% CI: 16.9, 24.5), and Washington County, Maryland 19.8/1000 person-years (95% CI: 16.1, 23.5). The lower stroke incidence rate in Allegheny County was consistent in gender, race, and age groups. Though not statistically significant, stroke mortality was also lower in Allegheny County than other 3 sites. The 1-month case fatality rate was similar in the 4 sites for all strokes, and by stroke types. Conclusions— Understanding geographic variations in stroke incidence may be an important step in improving preventive practices of stroke.

The authors studied mortality, vascular events, and preventive therapies following ischemic stroke among adults agedor =65 years.The authors identified 546 subjects with first ischemic stroke during 1989 to 2001 among Cardiovascular Health Study participants. Deaths, recurrent strokes, and coronary heart disease (CHD) events were identified over 3.2 years (median) follow-up.During the first year of follow-up, rates were 105.4/1,000 for recurrent stroke and 59.3/1,000 for CHD. After the first year, the stroke rate was 52.0/1,000 and the CHD rate was 46.5/1,000. Cardioembolic strokes had the highest mortality (185.4/1,000) and recurrence rates (86.6/1,000). Lacunar strokes had the lowest mortality (119.3/1,000) and recurrence rates (43.0/1,000). Age and male sex predicted death and CHD, but not recurrence. Outcomes did not differ by race. Following stroke, 47.8% used aspirin and 13.5% used other antiplatelet agents; 52.6% of patients with atrial fibrillation used warfarin; 31.3% of hyperlipidemic subjects, 57.0% of diabetic patients, and 81.5% of hypertensive patients were drug-treated; and 40.0% of hypertensive patients had blood pressure (BP)140/90 mm Hg. Older subjects were less likely to use lipid-lowering therapy, women were less likely to have BP140/90 mm Hg, and low-income subjects were less likely to use diabetes medications.Recurrent strokes were nearly twice as frequent as coronary heart disease (CHD) events during the first year after initial stroke, but stroke and CHD rates were similar after the first year. Preventive drug therapies were underused, which may reflect clinical uncertainty due to the lack of clinical trials among the elderly. Utilization was lower among the oldest patients, women, and low-income individuals.

Objectives: Soy isoflavones may have beneficial roles as antioxidants and phytoestrogens. Dietary intake varies widely across populations: very high in Japan but low in North America. We measured the concentrations of daidzein and genistein in the serum of Japanese men and women and evaluated their associations with metabolic markers. Methods: Serum samples were obtained from a population based sample of 94 Japanese men (mean age 45.3), and 142 Japanese women (mean age 66.6; 97% were post-menopausal). Isoflavones were analyzed after extraction and derivatization using GC-MS. Concentrations of daidzein and genistein were summed to obtain total isoflavone concentrations. Results: Isoflavone concentrations were very high among the Japanese. Median values (nM) for men: 558, 452 and 86 and for women 660, 494 and 150 (total isoflavones, genistein and daidzein, respectively). Spearman correlation coefficients for the isoflavones with multiple outcomes among Japanese men and women are shown in the table. No significant (p Discussion: The concentrations of isoflavones are high in the Japanese, approximately 50 times greater than those of N. Americans. Associations between the isoflavones and various outcomes were very weak for the Japanese men. This possibly reflects a plateau of isoflavone concentration has been reached that precludes observing any associations. Although, many correlations were calculated the positive associations of total isoflavones and daidzein with HDLc among women may be real. HDLc concentrations are high in Japanese women which may reflect the estrogenic actions of isoflavones.

Objectives: To compare incidence of coronary artery calcification (CAC) between men in Japan and the US and to examine whether marine n-3 fatty acids contribute to the difference in the incidence. Methods: The ERA JUMP Study is a population-based longitudinal study which has examined the progression of subclinical atherosclerosis in Japanese, Japanese American and white men aged 40-49 at baseline in 2002-2007. Incident cases of CAC were defined as those with CAC score=zero at baseline (n=278: 167 Japanese and 111 whites) and CAC score ≥10 at follow-up. Mean follow-up years were 6.2 for Japanese and 4.6 for whites. Stepwise robust logistic regression was used to determine baseline predictors of CAC incidence in each group. Generalized linear model was used to examine whether the difference in risk factors and marine n-3 fatty acids at baseline between Japanese and whites contributed to the difference in incidence rates. Results: Baseline characteristics show that levels of risk factors were similar between the two groups including LDL-C and BP. Exceptions were higher rates of smoking in Japanese (49 vs. 7%) and higher levels of HDL-C in Japanese (54 vs. 49 mg/dL). Levels of marine n-3 fatty acids were 100+% higher in Japanese. Incidence rate was significantly lower in Japanese than in whites (0.9 for Japanese vs. 2.9 for whites (per 100 person years) pTable ) Conclusions: CAC incidence is significantly lower in Japanese than in white men. The data suggest that high levels of EPA contribute to the lower CAC incidence in Japanese. Table. Incidence rate ratio of coronary artery calcification between Japanese men and white men (n=278) Incidence rate ratio between two groups (95% CI) (Japanese vs. whites) p -value Model I 0.606 (0.427, 0.861) Model II 0.571 (0.392, 0.830) Model III 0.669 (0.431, 1.038) 0.07 Model I: Adjusted for age, follow-up time, BMI, BP sys, HDL-C pack-years of smoking and LDL-C Model II: Further adjusted for triglycerides, glucose, hypertension medication, lipid medication, CRP and alcohol Model III: Further adjusted for EPA (eicosapentaenoic acid)

Objectives: We have previously reported that brachial-ankle PWV (baPWV) is more strongly related to lipoprotein subclasses than carotid-femoral PWV (cfPWV) among middle-aged white men. The current study examined the associations of baPWV, cfPWV and femoral ankle PWV (faPWV) with lipoprotein subclasses in Japanese Americans, Koreans, and Whites. Methods: The ERA JUMP Study is an international population-based study of subclinical atherosclerosis in men aged 40-49 without clinical CVD in the US, Korea, Hawaii and Japan. Participants for the current study were 310 whites, 303 Japanese Americans and 302 Koreans. PWV was assessed using an automated waveform analyzer (VP2000, Omron, Japan). Lipoprotein subclasses were assessed by NMR lipoproteins. Multiple linear regressions were performed to analyze the association of each PWV with NMR lipoprotein distributions after adjusting for age, body mass index, systolic blood pressure, and other potential confounders. Results: Both baPWV and faPWV had significant association with total, large, and small LDL-P after adjusting for race and other confounders, and across three racial groups except for faPWV in whites ( Table ). cfPWV had also significant associations with total and small LDL-P after adjusting for race and other confounders but these associations were weaker than those with baPWV and faPWV. Similarly, both baPWV and faPWV had significant associations with VLDL-P (total, large and small VLDL-P) and HDL-P (total, large, medium, and small HDL-P) but the associations of cfPWV with these lipoproteins were weaker and mostly non-significant. Conclusions: As compared to cfPWV, both baPWV and faPWV had stronger associations with lipoprotein distributions across three racial groups with very different lifestyle. Our results suggest that baPWV and faPWV are more related to atherosclerosis than cfPWV whereas cfPWV may represent arteriosclerosis. Table 1. Association between LDL subclasses(LDL-P) and carotid-femoral, brachial-ankle and femoral-ankle pulse wave velocities among young men in Korea, Hawaii and North America: Multiple linear regression derived beta (β) values (SE) @ Large LDL Small LDL Total LDL Particles cfPWV All participants $ −0.074 (.050) 0.405 (.204) * 0.152 (.072) * Whites −0.045 (.081) 0.442 (.309) 0.197 (.094) * Koreans −0.179 (.084) * 1.143 (.375) ** 0.337 (.140) * Japanese Americans 0.060 (.98) 0.064 (.361) 0.016 (.151) faPWV All participants $ −0.252 (.067) *** 1.201 (.264) *** 0.331 (.099) *** Whites 0.007 (.100) 0.368 (.389) 0.165 (.122) Koreans −0.252 (.113) * 1.609 (.502) ** 0.472 (.189) * Japanese Americans −0.501 (.152) ** 2.266 (.552) *** 0.698 (.225) ** baPWV All participants $ −0.310 (.053) *** 1.334 (.210) *** 0.404 (.075) *** Whites −0.212 (.108) * 1.220 (.415) ** 0.425 (.131) ** Koreans −0.245 (.079) ** 1.398 (.351) *** 0.493 (.126) *** Japanese Americans −0.194 (.098) * 1.132 (.357) ** 0.392 (.143) ** * p ** p *** p @ Adjusted for age, systolic blood pressure, body mass index, fasting glucose, pack-years smoking, alcohol intake and LDL cholesterol. $ Additionally adjusting for race.

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 …