Book Review

Stroke: Populations, Cohorts, and Clinical Trials

N Engl J Med 1994; 330:1465May 19, 1994

Article

Stroke: Populations, Cohorts, and Clinical Trials
Edited by Jack P. Whisnant. 263 pp. Boston, Butterworth-Heinemann, 1993. $65. ISBN: 0-7506-0574-X

This book of 15 chapters is part of a series of neurology textbooks published as Butterworth-Heinemann International Medical Reviews. Whisnant, the editor, is an internationally recognized expert on cerebrovascular disease. Dr. Whisnant, his colleagues at the Mayo Clinic, and his former trainees have each written several chapters. Many useful figures and tables accompany the text.

Emphasizing the epidemiology and natural history of stroke, this book often focuses on population-based studies performed in Olmsted County, Minnesota, and covers the design, conduct, and analysis of clinical trials. Particularly important is the review of the inherent limitations of such trials. Although the book includes detailed discussions of the potential value of the management of risk factors for vascular disease, medications to prevent stroke, and surgical treatments, less time is devoted to the management of acute stroke. The discussion of the methods in research on stroke and the chapter on the generalizability of clinical trials studying the natural history of stroke strengthen the book.

Stroke will be an important addition to the libraries of physicians doing clinical research in this area. Students and physicians who want an up-to-date summary of the natural history and epidemiology of stroke and those who want a better understanding of the issues related to the design of clinical trials and the generalizability of their results will find this specialized book useful. Although Whisnant's book evaluates the problems of stroke, the issues it discusses are equally applicable to clinical trials focused on other diseases.

Harold P. Adams, Jr., M.D.
University of Iowa College of Medicine, Iowa City, IA 52242