Sitting next to a picture of her father in a wheelchair after his stroke, with his paralyzed right arm tucked into his lap, Ann Spence said it just didn't occur to her that her own sudden weakness could be a stroke.
"That kind of thing doesn't happen to you," she said of her March 28 event, from which she appears to be fully recovered.
While the South does have more high blood pressure and diabetes than other areas of the nation, that doesn't account for all of the increased stroke deaths in the region, according to studies in this week's Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention. It could be any number of factors, some passed from generation to generation, and perhaps working in concert, stroke experts said.
For some, the increased risk starts early, said Daniel Lackland, a professor at Medical University of South Carolina who does population-based research on heart disease. In looking at the "Stroke Belt" of increased risk that crosses the South, and in looking at a similar area of increased disease in England, Dr. Lackland and an English researcher theorized that poor nutrition in poverty-stricken areas in previous generations could affect development in the womb and increase stroke risk later on. And it could be why southern blacks have the highest stroke burden, Dr. Lackland said.
"For instance, a low-birth weight baby is going to have a greater risk," he said.
"Not a great risk - it doesn't mean they're going to have a stroke. It just means that they have a slightly better risk of having a stroke later on. We know that African Americans are twice as likely to be low birth weight. We know that residents of the Southeast are more likely to be low birth weight than the rest of the country. Now there's a biological mechanism (for the increased risk)."
Add to that the traditional diet, he said.
"The Southeastern diet and the diet of African American may be just a tad higher in sodium, and (that plays into) the hypertension link."
Both Southerners and blacks are more likely to have hypertension. Both groups are also less likely to have health coverage, according to the CDC study, which can increase their risk if they also have high blood pressure or diabetes.
"If they're uninsured, you're really in trouble because people have hypertension that sometimes requires four drugs to treat," said David Hess, the chairman of the Department of Neurology at the Medical College of Georgia and a stroke researcher.
Both Dr. Hess and Dr. Lackland believe it is probably a blending of these factors that accounts for the greater number of strokes in this region.
"I think it's a combination of a number of things," Dr. Lackland said "It's like the residents of the Southeast, and African Americans have just a little bit more of different things that do provide that substantial risk."
Finding out which of those subpopulations might be at greater risk, and what intervention might be more effective, particularly for blacks, is one of the goals of the Stroke Outcomes Study at University Hospital, one of only four chosen for the CDC study, said principal investigator Harold C. McGrade, the director of stroke services at University.
One of those interventions is clearly more education about symptoms, he said.
"The most interesting thing that I think is sometimes misinterpreted is also the symptom that is most commonly present, and that is weakness of a limb," Dr. McGrade said.
Even though she is aware of stroke signs, Mrs. Spence couldn't believe her weakness and slurring at Cliffwood Presbyterian Church was a stroke until the pastor told her.
"I really didn't recognize it," she said. "He did."
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.
The symptoms of stroke almost always come on suddenly and include: - Weakness or numbness on one side, in an arm or a leg, or in the face, particularly if the feeling lasts more than 15-20 minutes
- Trouble speaking, slurring or sudden confusion
- Loss of vision or difficulty seeing in one eye or both
- Dizziness, loss of balance, coordination or difficulty walking
- Severe headache with no known cause
Source: Centers for Disease Control and Prevention