Strokes — the kind that kill — are much more common in the U.S. than in European nations, according to a new report.
American men are about 60% more likely than their European counterparts to have a stroke, said Mauricio Avendano, Ph.D., of Erasmus Medical Center in Rotterdam, at the American Stroke Association's International Stroke Conference. And American women are twice as likely to have a stroke as European women.
He noted that the ‘big three’ stroke risk factors — smoking, obesity and diabetes — were all more common in the U.S. than in Europe.
According to Dr. Avendano, the most likely explanation for this dramatic difference was "better preventive care in European countries." Prevention is a stressed in universal healthcare coverage, which is the norm in most parts of Europe.
He noted that the "big three" stroke risk factors — smoking, obesity and diabetes — were all more common in the U.S. than in Europe.
"This is because the sample includes people 50 or older," Avendano said. In coming years, this may change because "the smoking rate among younger Americans is lower than the smoking rate among younger Europeans. This difference may be reflected over the next 10 years."
Dr. Avendano and co-author Maria Glymour, Sc.D., of the Harvard School of Public Health, analyzed 18,398 participants culled from the U.S. Health and Retirement Study, 21,569 from the Survey of Health, Aging, and Retirement in Europe, and 8,551 in the English Longitudinal Study of Aging, all of which included biennial interviews with those ages 50 and older. They assessed risk factors including smoking, alcohol, physical activity, BMI, diabetes, education and income.
In all countries, most strokes occurred among men in their mid-60s and women in their mid-50s.
The stroke occurrence rate for men and women 50 and older in the U.S. was 6.8% versus an average of 4.5% across all European countries.
Mediterranean countries such as Italy, Greece and Spain had the lowest rate, which may reflect the influence of the so-called Mediterranean diet. But another country with a low stroke rate was Switzerland, which is known more for its love of chocolate and other rich fare than for its consumption of fruits, vegetables and fish.
When the data were broken down by wealth, poor Americans had the highest stroke rate, but even wealthy Americans had a higher rate than poor Europeans.
The authors also argued that risk factors explained only a small fraction of the higher occurrence rate of stroke in the U.S. compared with European populations, "which points at the role of broader healthcare and structural policies in determining stroke prevalence."
These data were presented in abstract form to the 2008 American Stroke Association International Stroke Conference, held in New Orleans 2/20-2/22, 2008.