Stroke rates and deaths fall in large U.S. study

Stroke rates and deaths fall in large U.S. study

Stroke rates and deaths fall in large U.S. study

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by KIM PAINTER / Special for USA TODAY

KING5.com

Posted on July 16, 2014 at 9:39 AM

Updated Wednesday, Jul 16 at 9:39 AM

People are having fewer strokes and dying less often in the wake of strokes, at least in four U.S. communities followed closely over more than two decades.

Results from the study, published Tuesday in the medical journal JAMA, help explain and expand upon nationwide statistics showing stroke deaths dropping over recent years.

Those statistics are based on death certificates listing stroke, but do not show whether people are actually having fewer strokes or just dying less often after their strokes, says study co-author Josef Coresh, director of cardiovascular epidemiology at the Johns Hopkins University School of Public Health in Baltimore. Most reports also don't include deaths following strokes that may be related but are attributed to heart attacks, pneumonia, falls and other ills, he says.

The new report includes all of those deaths and still manages to find a decrease in deaths, along with a decrease in strokes themselves. The improvements extend to blacks and whites, men and women. "That's good news," Coresh says.

Still, stroke remains the fourth-leading killer in the United States, striking 800,000 people a year and killing 130,000, according to the federal Centers for Disease Control and Prevention. Stroke — a so-called 'brain attack' in which a blood vessel bursts or becomes blocked by a clot — is also a major cause of disability.

The new study, part of a large, ongoing research project on stroke, followed 15,792 people ages 45 to 64 from 1987 to 2011. They came from Jackson, Miss.; Washington County, Md.; Forsyth County, N.C.; and Minneapolis.

During those 24 years, 7% had a first stroke and 58% of those people eventually died. Over each decade, the rates of stroke and death fell, by about 24% and 20%, respectively.

There were some exceptions, based on age: Stroke rates did not fall significantly among people under age 65 and death rates did not fall as much among those over 65.

Preventing strokes in younger people and helping older people survive should get more attention, the researchers say.

The improvements seen so far can be attributed to a number of factors, they say, including better control of blood pressure and cholesterol, less smoking and better medical care after strokes.

"But on the opposite side, diabetes has increased," and that, along with high obesity rates, could bode ill for the future, Coresh says.

Increases in obesity and diabetes and declines in physical activity might help explain why stroke rates are not falling in middle-aged adults, says an editorial accompanying the study and written by Ralph Sacco and Chuanhui Dong of the University of Miami. They also say that the improvements seen in blacks in the study, who came primarily from Forsyth County and Jackson, might not be seen nationwide. Blacks have a much higher stroke risk than whites.

The improvements among blacks in the study are nonetheless "very noteworthy" and encouraging, says Sacco, a neurologist.

Sacco says the keys to "brain health" and to fewer strokes, for young and old, black and white, are to "know your numbers, your blood pressure and cholesterol, and get treated if you can't get them under control with lifestyle management."

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