High prevalence of obstructive sleep apnea syndrome in Spain’s Stroke Belt

Objective Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among patients with acute ischemic stroke (AIS) in southern Spain. Methods We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients <72 hours after AIS with a neuroimaging lesion and performed sleep tests. Results Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients. Conclusions The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS.

Correlates of a southern diet pattern in a national cohort study of blacks and whites: the REGARDS study

Background: The Southern dietary pattern, derived within the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, is characterized by high consumption of added fats, fried food, organ meats, processed meats, and sugar-sweetened beverages, and is associated with increased risk of several chronic diseases. The aim of the present study was to identify characteristics of individuals with high adherence to this dietary pattern. Design: We analyzed data from REGARDS, a national cohort of 30,239 black and white adults ≥ 45 years of age living in the US. Dietary data were collected using the Block 98 Food Frequency Questionnaire (FFQ). Multivariable linear regression was used to calculate standardized beta coefficients across all covariates for the entire sample and stratified by race and region. Results: We included 16,781 participants with complete dietary data. Among these, 34.6% were black, 45.6% male, 55.2% resided in stroke belt region, and the average age was 65 years. Black race was the factor with the largest magnitude of association to the Southern dietary pattern (Δ = 0.76 SD, p < 0.0001). Large differences in Southern dietary pattern adherence were observed between black participants and white participants in the stroke belt and non-belt (stroke belt Δ = 0.75 SD, non-belt Δ = 0.77 SD). Conclusion: There was a high consumption of the Southern dietary pattern in the US black population, regardless of other factors, underlying our previous findings showing the substantial contribution of this dietary pattern to racial disparities in incident hypertension and stroke.

Design of REGARDS: A National Cohort of Black and White Adults to Study Disparities in Stroke and Cognitive Function

The REGARDS study enrolled 30,239 whites and blacks aged &gt;45 from 2003 – 2007, with oversampling of blacks and residents of the Stroke Belt. Potential participants were mailed a letter/brochure followed by telephone call. After verbal consent, telephone interview assessed cardiovascular health and cognitive function. In a home visit, measurements of risk factors, biological samples, EKG, written consent were obtained; during the in-home visit, self-administrated questionnaires were left to be completed and returned. Participants are followed for hospitalizations via telephone at 6-month intervals. Annually and biennially, brief and more comprehensive assessments of global cognitive function are conducted. Medical records for suspected strokes are collected with adjudication by stroke experts. A 2nd in-home and telephone assessment was conducted 2013-2016, approximately 10 years after baseline. This presentation will describe the methodological details of REGARDS, progress on the specific aims of the current grant, and establish the context for the remaining presentations.

Differential Association of Geographical Region of Birth With Dementia Risk Across Black Women and Men

Risk of dementia is both racially and spatially patterned. Less is known about sex/gender differences in pathways linking birth place to late-life cognitive outcomes in older non-Latino Blacks. The 1464 Black men and women included in these analyses were Northern Manhattan residents. Cox regressions revealed that Stroke-Belt South (SB) and Non-Stroke-Belt South (NSB) birth was associated with a higher dementia risk, adjusted for birth year, childhood SES, and risk of death. Compared to Northern-born (NB) men, SB men had the highest risk, followed by NSB women and SB women, while NSB men and NB women had a similar risk to NB men. The higher risk for SB men and NSB women remained after adjusting for education, adult income, and CVD burden. Future work should identify why birth in the SB is uniquely detrimental for cognitive health among Black men, while birth in NSB has the strongest impact on Black women.

Nutrition and Cerebrovascular Disease

Stroke is a major public health burden in the United States and worldwide and is a leading cause of long-term disability and lost wages. The southeastern United States, nicknamed the “stroke belt,” is disproportionately affected by stroke, with African Americans being the most affected. Multiple theories exist about the basis for this, one of which is the diet quality that prevails in the southern United States. Indeed, diet has long been known to be an independent risk factor for cardiovascular disease in general, and stroke in particular. This chapter discusses the relation between diet and stroke. We explore the intersections of cardiovascular and nutrition science and discuss the different components of diet as well as the different dietary patterns and how they affect stroke risk. Finally, we recommend how physicians and healthcare providers can mitigate cardiovascular risk by properly counseling their patients. This chapter is meant to be used as guidance for the data needed to support our daily decisions when counseling patients.