Heart attacks and strokes wreak havoc throughout Europe but often travel incognito. A majority of people in nine European countries recognize few or no warning signs of these potentially deadly conditions, a new study finds.

About half of Europeans don’t realize that it’s best to call an ambulance when someone displays stroke symptoms, say psychologist Jutta Mata of the University of Basel in Switzerland and her colleagues. People with high blood pressure or who are obese — two key risk factors for heart attack and stroke — knew no more about warning signs or how to respond to strokes than anyone else, the researchers will report in Health Expectations.

“Across all nine countries, people knew surprisingly little about heart attack and stroke symptoms and how to react to them,” Mata says.

The findings come from a sample of 10,228 inhabitants of Austria, France, Germany, Italy, the Netherlands, Poland, Russia, Spain and the United Kingdom. Participants’ ages ranged from 14 to 98.

Mata’s team analyzed health data collected as part of a massive European consumer survey conducted in late 2006.

Among six established warning signs of a heart attack, chest pain was the only symptom recognized by most people — 80 percent. Almost half the participants linked shortness of breath and arm or shoulder pain to heart attacks. That figure fell to 21 percent for anxiety and for intense nausea and dizziness, and dropped to 7.5 percent for stomach pain.

Among 14 warning signs of a stroke, volunteers most often recognized slurred speech, paralysis and a lopsided face. But no symptom was recognized by more than 44 percent of Europeans. Nineteen percent didn’t know any stroke symptoms.

Italians, Spaniards, Poles and Russians recognized the fewest heart attack and stroke symptoms.

These findings highlight a disturbing lack of health knowledge among Europeans, but it’s unclear whether educational efforts would work best via physician discussions, public-service messages or other strategies, Mata says.

A random telephone survey of 76,864 U.S. citizens in 2007, led by epidemiologist Jing Fang of the Centers for Disease Control and Prevention in Atlanta, found that most participants reported knowing at least one of five symptoms of each condition. But fewer than 20 percent of people recognized all relevant symptoms, knew that decoy symptoms mentioned by interviewers didn’t apply and said that they would call 911 if someone had a heart attack or stroke.

In that study, volunteers were asked to say “yes” or “no” to six possible signs of heart attacks and strokes, five of which were actual symptoms. A tendency to say “yes” to please the interviewer or as a default strategy may have made it seem like participants knew more than they actually did, Fang says.

Questions also remain about the accuracy of the European findings, asserts internist Lisa Schwartz of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.

Interviewers contacted set numbers of people in different economic and social groups within each country, a method that may not yield a truly representative sample, Schwartz says. Results for young women, for instance, would vary greatly if they were predominantly contacted at an STD clinic, a shopping mall or an SAT course.

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Found in: Body & Brain and Psychology