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African-Americans Unaware of Stroke Risks

Jan 11, 2003

Nearly 90 percent of the study subjects had a history of high blood pressure, but more than 25 percent did not take medication to control it. Although controlling high blood pressure and cholesterol could prevent thousands of heart attacks and strokes each year, a new study released Monday suggests many African-Americans are unaware of the dangers these conditions pose and are failing to follow good health practices.

Blacks are at a higher risk than Caucasians for heart attack and stroke because in general they are more likely to have high blood pressure, diabetes, high cholesterol and other risk factors. Yet the study found many African-Americans who had suffered a stroke had undiagnosed or uncontrolled diabetes, high blood pressure or high cholesterol, Sean Ruland, assistant professor of neurology at Rush Medical College and lead author of the study, told United Press International.

This suggests either the patients themselves were unaware of the seriousness of these risk factors or their doctors failed to keep these conditions under control, Ruland said.

The situation is "probably magnified in people who have not had a stroke because they haven’t had an event that caused them to seek out medical treatment," Ruland said.

"The unawareness rates are alarming and not being treated to goal is alarming," Ruland said. "That means we have problems on both ends," both the patients and the doctors, he said.

This is "not satisfactory considering the increasing evidence that (heart disease) and (stroke) can be prevented with vigilant risk factor management," Ruland’s group reports in the Jan. 14 issue of the journal Neurology.

More than 1 million heart attacks and 731,000 strokes occur in the United States each year and experts have advised controlling known risk factors could prevent many of these.

"We must address these factors and improve risk factor awareness, treatment, and control if we are to decrease the prevalence of (heart disease) and (stroke) — the number 1 and 3 killers in the United States," the journal article states.

Lack of awareness of the need to control risk factors could include "physician attitudes, patient access to care, and public knowledge of the importance for routine screening and adherence to treatment guidelines," the article continues.

"This is a wide-ranging problem. There is not going to be a magic bullet here," Larry Goldstein, director of the stroke center at Duke University in Durham, N.C., and chair of the American Stroke Association advisory committee, told UPI.

"Patients need to be aware of their risk factors and participate in their treatment and communicate with their healthcare providers," Goldstein said. Healthcare providers "need to make sure they address these risk factors (in their patients) and do appropriate follow-up" to make sure high cholesterol and blood pressure is being kept under control, he added.

Ruland and colleagues based their findings on the African-American Antiplatelet Stroke Prevention Study, a trial of more than 1,000 stroke patients with an average age of 62 to determine how effective an anti-clotting drug plus aspirin is in preventing additional strokes or heart attacks

They found:

— Nearly 90 percent of the study subjects had a history of high blood pressure, but more than 25 percent did not take medication to control it. High blood pressure is considered to be one of the most significant risk factors for stroke, but medication can keep it in check and reduce stroke risk.

— Of the patients on high blood pressure medication, 70 percent still had elevated blood pressure.

— Of the 143 patients with no history of high blood pressure, more than half had blood pressure that was elevated.

— Of the patients who had diabetes, 84 percent were on medication for the condition but one-third had inadequate control of their blood sugar levels.

— Of the patients with no history of diabetes, 2 percent showed significantly elevated blood sugar levels, indicating they were at high risk for the disease.

— Of the patients who were found to have elevated cholesterol levels and taking medication to keep it in check, 28 percent still had elevated levels.

— Almost 25 percent of those not reporting a history of high cholesterol were found to have elevated levels