Aggressive Medical Management Can Reduce Risk of Stroke Recurrence in Black Adults

Black adults have more stroke risk factors than non-Black adults, according to a study published by the American Heart Association (AHA) in Stroke. A year of intensive intervention, which includes lifestyle coaching and regular follow-up care, can significantly reduce stroke risk factors, the study found.

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“These disparities may be resolved by tailoring care to include lifestyle coaching, medication alterations or additions if appropriate, access to routine health care support and regular physician follow-up,” said study co-author Ashley Nelson, DO, in an AHA press release.

AHA researchers conducted a retrospective analysis of patient health data from the 2008 to 2011 Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study, which evaluated aggressive medical management for stroke recurrence in patients who previously suffered from stroke.

At study enrollment, Black participants were younger (57 years of age compared to 61) and more likely to have high blood pressure (95.2% versus 87.5%); type 2 diabetes (52.9% versus 39.7%); higher average diastolic blood pressure (82.4 versus 79.5 mm Hg); and be less physically active.

In the current analysis, AHA authors compared patient medication use and cardiovascular risk factors, such as systolic and diastolic blood pressure, low-density lipoprotein, blood glucose levels, and physical activity—evaluated with PACE (Physician-based Assessment and Counseling for Exercise) score—between Black and non-Black adults who recently experienced stroke.

With 1 year of intensive intervention, the average PACE score of Black adults increased from 2.7 to 4.2 (within the target range of 4 or more). Non-Black adults increased their score to 4.1.

The medical intervention incorporates dual antiplatelet therapy, regular follow-up visits with the health care team, lifestyle coaching, and intensive control of vascular risk factors such as blood pressure. After a year of intervention, Black adults reduced their diastolic blood pressure to 74.7 mm Hg compared to 75.7 mm Hg in the non-Black cohort, which included patients who are White, Asian, and Hispanic.

“We tend to focus on systolic blood pressure, yet diastolic blood pressure is also a good marker for cardiovascular health and the integrity of the blood vessels,” Nelson said in the release. “Using a tailored approach resulted in better risk factor control for the participants.”

Remediating diastolic blood pressure may have also contributed to a 2-times greater increase in use of diuretic medication among Black adults.

SAMMPRIS was a randomized controlled trial comparing aggressive medical management to stenting for recurrent stroke prevention. The cohort included 451 adults with stroke caused by severe intracranial atherosclerotic stenosis, characterized by a 70% narrowing of the major brain artery.

The original SAMMPRIS results show that patients who received aggressive medical management had a 5.8% risk of experiencing second stroke or death at 30 days. Conversely, patients who received intracranial stent and intense intervention had a 14.7% risk of second stroke or death at 30 days.

“Many different approaches are needed to reduce and eliminate these disparities in Black adults. Access to health care, lifestyle coaching, early follow-up and administration of appropriate medications after stroke may help to resolve it, but not wholly in terms of overall risk and all of the baseline disparities,” Nelson said in the press release.

Reference

Disparities in Black adults’ stroke risk factors persist; risk factor control reduced gap. American Heart Association. News Release. August 3, 2023. Accessed on August 3, 2023. https://www.eurekalert.org/news-releases/997143