Factors Explaining Excess Stroke Prevalence: The Spanish Stroke Belt

Abstract

Factors Explaining Excess Stroke Prevalence:The Spanish Stroke Belt To the Editor:We have read with interest the article of Liao et al on factors explaining excess stroke prevalence in the US stroke belt. 1 Identifying the factors contributing to stroke disparities is clearly an important question, as long as the precise reason for this has been a topic of debate and controversy for decades. Moreover, we consider that when these results are also congruent with the data published in other countries, the key role of these factors on stroke disparity is reinforced.Stroke remains a major health care problem in Spain. 2 In addition, as in the United States, rates of stroke prevalence and mortality also differ largely among different parts of the country. Likewise, an area in southeastern Spain has an unusually high rate of strokes and other forms of cardiovascular disease, particularly the area of Andalusia, with Ϸ50% higher stroke mortality rates. 2 Remarkably, and according to Liao et al data, in this area, we also find the highest incidence of prevalent chronic diseases (hypertension, diabetes, and coronary heart disease), risk factors (overweight, obesity, and smoking), 3 and the worst socioeconomic status (education and income). 4 Thus, for instance, in Andalusia, among the population Ն60 years of age, the prevalence of diagnosed hypertension and the prevalence of ECG-left ventricular hypertrophy are 79.4% and 19.6%, respectively, the highest values in the Spanish population (with a mean of 73% and 12.9%, respectively). 3,5 Furthermore, the control rate of hypertension in this population is 28.5%, which is the lowest in the country. 3 As expected, a direct relationship between stroke mortality rates and the prevalence and control rates of hypertension has been demonstrated. 3,5 Therefore, the effect of these factors on the total burden of stroke in different countries is similar and substantial. Additional global efforts are needed to understand and reduce these huge disparities and finally eliminate these stroke belts. DisclosuresNone.

Ipsilateral Motor Pathways after Stroke: Implications for Non-Invasive Brain Stimulation

“…Second, suppression of contralesional M1 may be contraindicated in more severely affected stroke patients (Bradnam et al, 2012). Third, the proposed CRPP model supports the emerging view that NBS neuromodulation should be tailored individually for patients after stroke based on impairment level (at the chronic stage) (Cramer, 2010; Stinear, 2010; Bradnam et al, 2012) and perhaps, based on the residual capacity of their descending motor pathways (at the sub-acute stage). Further research examining the full range of neurophysiological effects induced by NBS seems warranted.…”

Regional differences in ischemic stroke in India (north vs. south)

“…1 Regional differences are documented across different parts of the world, for example in the “stroke belts” in USA, Spain, and China. 2–4 In China, there is a higher incidence of stroke in the northern areas. Regional differences have been noted in Thailand with higher stroke prevalence rates in cities and central regions.…”

Direct Mechanical Thrombectomy vs. Bridging Therapy in Stroke Patients in A “Stroke Belt” Region of Southern Europe

“…Demographic data and comorbidities were similar in both groups. Among the included patients, the median NIHSS score at baseline was 17 [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ] and the most frequently affected territory was the anterior circulation (87.3%). Cardioembolic etiology, found in 51% of the samples, was the most prevalent.…”

“…In Europe, the burden of vascular risk factors, cerebrovascular disease mortality, and stroke management protocols differ among the different areas. In Spain, situated in the south of Europe, there is a specific southern region of the country (regions of Andalusia and Murcia) where higher rates of cardiovascular factors and stroke mortality have been reported, called the “Stroke Belt” [ 15 , 16 , 17 ]. Similarly, Andalusia is a region with a large degree of geographical dispersion, where a high percentage of patients are initially referred to a hospital without a neurologist and, if needed, subsequently transferred to a stroke center (SC), according to a drip-and-ship model.…”