Residents of the southeastern “stroke belt” may begin developing a higher risk of stroke death at an early age. Healthy habits started as a teen may be key to lowering later stroke risk.
It is well established that a healthy lifestyle – including no smoking, physical activity, a healthy diet and maintaining a normal body mass index (BMI) – can significantly reduce stroke risk.
Many people living in parts of the South do not follow these healthy behaviors.
New research has found that the teen years may be a key period of vulnerability for those living in this region.
Virginia Howard, PhD, of the School of Public Health, University of Alabama at Birmingham and a member of the American Academy of Neurology, worked with her fellow scientists to analyze data on 24,544 people with an average age of 65 who had never had a stroke at the start of the study.
Data came from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national random sample of the general population with more people selected from the stroke belt.
About 57 percent of study subjects were currently living in the stroke belt and 43 percent were living in the rest of the country.
The National Heart, Lung, and Blood Institute has designated 11 states as the stroke belt: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia.
This study tracked each participant's moves from birth to present, with some people moving into or out of the stroke belt. The participants were then followed for an average of 5.8 years. During that time, 615 people had their first stroke.
People who spent their teenage years in the stroke belt were 17 percent more likely to have a stroke in later years than people who did not spend their teenage years in that area.
Across all age periods, living in the stroke belt was linked to about a two-fold increased risk of stroke for African Americans compared to Caucasians.
“This study suggests that strategies to prevent stroke need to start early in life,” said Dr. Howard.
“Many social and behavioral risk factors, such as smoking, are set in place during the teenage years, and teens are more exposed to external influences and gain the knowledge to challenge or reaffirm their childhood habits and lifestyle.”
Carol Wolin-Riklin, RD, metabolic and bariatric nutrition coordinator of Minimally Invasive Surgeons of Texas, University of Texas Medical School at Houston, told dailyRx News, “This study has given new meaning to the age old adage ‘You are what you eat.’
"The adage may now need to be modified to be ‘You are as an adult what you eat as a child.’ The impact of regional diet and lifestyle can and will alter long-term health outcomes at an earlier age than we could have predicted. This illustrates the need for programs to focus on early healthy eating and lifestyle interventions to promote health status as populations age.”
In a related editorial, Luis Castilla-Guerra, MD, of the University of Seville in Spain, wrote, “Future research must pinpoint how early life environment and lifestyle factors have lasting effects on stroke risk. Helping adolescents establish healthy lifestyles and avoid developing risky health behaviors also seems to be crucial and should be started before these behaviors are firmly established.”
The study was published online April 24 in Neurology, the medical journal of the American Academy of Neurology. The research was supported by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging.