U.S. “stroke belt” also hit by heart failure

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People who live in the southeastern U.S., already dubbed the nation’s “stroke belt,” may have a higher-than-average rate of death from heart failure as well, a new study finds.

Researchers found that across the six contiguous southeastern states—Alabama, Arkansas, Georgia, Louisiana, Mississippi and Oklahoma—the rate of death from heart failure was 31 per 100,000 people.

That was 69 percent higher than the national average of 18 heart-failure deaths per 100,000 people, the researchers report in the American Journal of Cardiology. And the regional disparity was seen among both whites and African Americans.

The southeastern U.S. has long been known as the nation’s “stroke belt” because stroke death rates are about 50 percent higher there compared with the rest of the country.

But the current study appears to be the first to I.D. the southeast as the nation’s “heart failure belt,” according to Marjan Mujib and colleagues at the University of Alabama at Birmingham.

Heart failure is a chronic condition in which the heart gradually loses its ability to efficiently pump blood to the body—causing symptoms like breathlessness, fatigue and fluid build-up in the limbs. It arises from underlying conditions that damage the heart—most often clogged arteries, a heart attack or uncontrolled High Blood Pressure.

Heart failure and stroke share some risk factors, including clogged arteries, High Blood Pressure and diabetes. But they are also two very distinct conditions, so the researchers were not sure what kind of geographical pattern they would find going into this study, said senior investigator Dr. Ali Ahmed.

Zeroing in on the southeast as the heart failure belt is a first step toward finding ways to change that pattern, according to Ahmed.

In an email, he pointed to ongoing research looking at the underlying reasons for the stroke belt. So far, researchers have found that “traditional” risk factors for stroke—like High Blood Pressure, diabetes and African-American race—seem to explain only half of the excess risk of stroke death in the southeast.

So now they’re looking at non-traditional factors, like education and income, environmental exposures and specific diet habits.

One recent finding, Ahmed said, is that certain diet patterns in the southeast—like a high intake of fried fish—might help explain the higher death rate from stroke.

As for heart failure, Ahmed said, the higher death rate could either mean that people in the southeast are more likely to develop heart failure than other Americans are, or that when they do they are more likely to die from it. Or it could be both.

It could be that higher rates of clogged arteries, High Blood Pressure and diabetes explain the heart failure belt, according to Ahmed. It could also be that people in the southeast are more likely to progress to severe heart failure, possibly related to differences in the quality of their healthcare.

More research, Ahmed’s team says, is needed to weed out the reasons for their findings.

SOURCE:  American Journal of Cardiology, online January 19, 2011.

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