May 8, 2008

•  Focus is on underpinnings of Southeast's Stroke Belt

•  In-home assessments key to representative study mix

BIRMINGHAM, Ala. - The nation's largest study aimed at exploring regional and racial differences in stroke illness and stroke death has earned a $20.8 million grant renewal.

The funding renewal puts the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which has enrolled more than 30,200 U.S. study participants, in a position to inspire and generate data for groundbreaking research on understanding stroke and improving prevention, screening and treatment, said researchers at the University of Alabama at Birmingham (UAB).

The National Institute for Neurological Disorders and Stroke has awarded UAB a $20.8 million renewal of its REGARDS study.

"REGARDS study leaders and volunteers deserve this honor and much more," said Max Michael, M.D. dean of the UAB School of Public Health, which houses the research and data-collection team for the study.

"Usually such studies involving careful follow-up of large numbers of people come from within the National Institutes of Health. UAB researchers have shown they have the forethought and expertise needed for such a historic project," Michael said.

FOCUS REMAINS ON STROKE BELT

The $20.8 million grant will focus primarily on determining the reason for higher stroke death rates in eight southeastern states known as the Stroke Belt - Alabama, Arkansas, Louisiana, Mississippi, North and South Carolina, Georgia and Tennessee - and explore why stroke death rates are higher among African-Americans than whites. Thousands of study participants live in those eight states, with 44 percent of participants living in other states.

Another focus of REGARDS will be to explore the genetic, environmental or lifestyle factors that impact personal stroke risks. REGARDS investigators also are examining stroke changes in cognitive abilities, public perception of stroke symptoms and what are the signs for undiagnosed ‘whispering' strokes.

"One of the great strengths of this study, something that sets it apart, is that we go into the communities and into the homes of study participants to gather the measurements we need, from height and weight to blood pressure readings, prescription names and other details," said George Howard, Dr.P.H., professor of biostatistics in the School of Public Health and the study's principal investigator. "Other studies, like the Framingham Heart Study or the Cardiovascular Health Study, ask participants to go into the clinic."

The in-home aspect of the study allows REGARDS data to be more racially and regionally mixed. In-clinic studies often are limited to one town or one region, said Virginia Howard, Ph.D., another lead study investigator and an epidemiologist at UAB.

In-home visits to REGARDS volunteers are contracted out to a national examination company with thousands of workers. Also, direct mail and telephone calls are used to stay in close contact with the 30,228 study enrollees all aged 45 and older.

REGARDS already has spawned more than 80 accompanying research reports, including one finding that about half of all people who reported a stroke symptom had failed to see a doctor for those symptoms. Another REGARDS report showed that African-Americans were more likely than whites to recognize high blood pressure and get medical treatment, but African-Americans on average still had higher blood pressure.

The study is a research partnership that includes UAB's departments of Epidemiology, Biostatistics and Preventive Medicine, UAB's Center for Aging and the Center for the Study of Community Health, the University of Vermont in Burlington, the University of Arkansas for Medical Sciences in Little Rock, the University of Cincinnati, Indiana University in Indianapolis, the Alabama Neurological Institute in Birmingham, the Medical University of South Carolina in Charleston and Wake Forest University School of Medicine in Winston-Salem, N.C.