Howard VJ et al. (2006) High prevalence of stroke symptoms among persons without a diagnosis of stroke or transient ischemic attack in a general population: the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. Arch Intern Med 166: 1952–1958

Undiagnosed strokes are common—using MRI, the 1998 ARIC study documented clinically silent cerebral infarctions in 11% of adults aged 55–64 years. The REGARDS study, published recently in the Archives of Internal Medicine, set out to further investigate the prevalence of stroke symptoms in a general US population (i.e. people who had not been diagnosed with stroke or a transient ischemic attack) and the association of these symptoms with recognized risk factors, as defined by the Framingham stroke risk score. Information was first obtained by telephone interview, with a physical examination performed 3–4 weeks later. A final cohort of 18,462 participants (mean age 65.8 years) was available for analysis.

One or more symptoms of stroke, such as sudden weakness, numbness or loss of vision, were reported by 3,292 subjects—17.8% of the group. Multivariate analysis showed that stroke symptoms were more common among African American participants than white participants, and among participants with less education, lower income and poorer self-reported general health. There was a greater prevalence of stroke symptoms among subjects with high Framingham stroke risk scores. Targeted education and attempts to ameliorate risk factors such as hypertension, atrial fibrillation and smoking should be employed as preventative measures for patients who report symptoms of stroke. Follow-up of the REGARDS cohort will reveal whether or not those who reported symptoms and sought medical attention had actually experienced a stroke.