title: Geographic patterns in overall and specific cardiovascular disease incidence in apparently healthy men in the United States.
abstract: OBJECTIVE
  Residence in the Southeastern United States (US) has been linked to increased stroke incidence and mortality. However, data on regional variability in overall cardiovascular disease (CVD) and specific coronary heart disease incidence are sparse.
  
  
  METHODS
  We assessed the risk of major CVD (nonfatal stroke, nonfatal myocardial infarction, or death from CVD) and specific CVD associated with region of residence (Northeast, Southeast, Midwest, and West) in 17 927 apparently healthy male participants of the Physicians' Health Study. Subjects were aged 40 to 84, most were white (93%), and had no previous CVD at baseline. We used residence in the Northeast as the reference group and proportional hazards models to adjust for potential confounding.
  
  
  RESULTS
  We found no difference in risk of major CVD between regions of residence. Further, we found no consistent association between myocardial infarction and CVD death and region of residence. In contrast, we found a significantly increased risk of total stroke (HR, 1.22; 95% CI, 1.02 to 1.47) associated with residence in the Southeast compared with the Northeast. This relative risk was further increased for ischemic stroke (HR, 1.30; 95% CI, 1.06 to 1.58). We saw no difference in risk of any outcome when categorizing state of residence into tertiles based on mean winter temperature, mean summer temperature, or into 2 groups based on latitude.
  
  
  CONCLUSIONS
  In this homogenous and well-characterized cohort of US male physicians, we found greater incidence of ischemic stroke, but not other vascular events among those living in the Southeastern US, compared with other regions.
authors.affiliation: Department of Epidemiology, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, NJ, USA.
authors.forename: David Q
authors.initials: DQ
authors.lastname: Rich
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality*; D002980:Climate; D015331:Cohort Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010809:Physical Fitness / Q000502:physiology; D010820:Physicians / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology