St. Paul, Minn. – Many of the 1.1 million heart attacks and 731,000 strokes that occur each year in the United States might be prevented by controlling risk factors. Among those with a history of heart disease or stroke, African Americans could possibly benefit most from a greater degree of awareness and control of risk factors, as they are significantly more likely to have a higher risk factor profile than many other groups.
According to a study published in the January 14 issue of Neurology, the scientific journal of the American Academy of Neurology, inadequate rates of awareness and control of risk factors remain prevalent among African American stroke patients. Risk factors studied include hypertension, diabetes, cigarette smoking, excessive alcohol use, and high cholesterol.
“We sought to determine rates of awareness, treatment and control of major risk factors among patients at the time of enrollment into the African American Antiplatelet Stroke Prevention Study (AAASPS),” said study author Sean Ruland, DO, of Rush University in Chicago. The AAASPS is a clinical trial comparing the effectiveness of ticlopidine hydrochloride (an anti-clotting agent) with aspirin in preventing recurrent stroke, heart attack and other vascular-related death.
Study authors performed baseline assessments with the 1,086 patients enrolled in the study as of June 1999. Assessments included a medical and neurologic history, physical exam, and laboratory analysis consisting of a complete blood count, metabolic profile, lipid profile, and urinalysis.
Hypertension (high blood pressure), perhaps the most significant risk factor for stroke, was found in the majority of study patients. Of the high number of patients (87 percent) who reported a history of hypertension, more than one-fourth did not take antihypertensive medication.
More than half of these had an elevated blood pressure (higher than 140/90 mmHg). Of those that were taking antihypertensive medication (690 patients), 70 percent still had an elevated blood pressure. Of the 143 patients with no reported history of hypertension and no use of medications, more than half (74) had an elevated blood pressure.
Of the 40 percent of patients (433) with known diabetes mellitus, 363 (84 percent) reported being on medication for diabetes. Of the 60 percent of patients who reported no history of diabetes and the seven patients who were uncertain of their diabetic status, 2 percent had an elevated serum glucose level (greater than 200 mg/dl), indicating risk for diabetes.
A history of hypercholesterolemia (high cholesterol) or use of a lipid-lowering agent was reported by 424 patients (39 percent).
“Our study shows that of the patients with known diabetes, one-third demonstrated inadequate control of the disease,” noted Ruland. Also, among the 73 percent taking antihypertensive medication (of the 87 percent of study patients who reported a history of hypertension), more than two-thirds still had an elevated blood pressure.
“Our data indicate poor rates of awareness, treatment, and control of diabetes, hypertension, and high cholesterol among study participants -- African Americans with previous stroke at the time of study enrollment,” stated Ruland. He also noted that these rates are comparable to the community at-large and are entirely unsatisfactory considering the increasing evidence that heart disease and stroke can be prevented with vigilant risk factor management.
Ruland concluded, “We must identify and address the underlying reasons why the African American population appears to be less aware of and/or less likely to control the risk factors contributing to our nation ’s number one and number three killers.”
This study was supported in part with funding from the National Institutes of Health.
The American Academy of Neurology, an association of more than 19,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, autism and multiple sclerosis.
For more information about the American Academy of Neurology, visit www.aan.com.
- end -