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African-Americans and stroke risk

John W. Cole, MD, MS and Steven J. Kittner, MD, MPH | 5/20/2016, 8 a.m.
Stroke is a very common medical problem throughout the United States and worldwide.
John W. Cole, MD, MS and Steven J. Kittner, MD, MPH

Stroke is a very common medical problem throughout the United States and worldwide. In the United States there are typically about 800,000 new or repeat strokes each year. Stroke is the fourth highest cause of death in the United States and the leading cause of long-term disability. Although certain risk factors for stroke, such as genetics or family history cannot be controlled, others such as high blood pressure or diabetes can go unrecognized. Knowing your risk factors for stroke and controlling them is the first step in preventing a stroke.

African Americans are more impacted by stroke than any other racial group within the American population and the statistics are staggering. African-Americans are twice as likely to die from stroke as Caucasians and their rate of first strokes is almost double that of Caucasians. Strokes among African-Americans also tend to occur earlier in life. Further, as stroke survivors, African-Americans are more likely to become disabled and experience difficulties with daily living and activities. So why are African-Americans at higher risk? Unfortunately the full explanation is unclear; however, research points to hypertension and diabetes as major reasons for the excess risk among African-Americans. High blood pressure is the number one risk factor for stroke, and one in three African Americans suffer from high blood pressure. African Americans are more likely to develop hypertension at a younger age and less likely to have it under control than other Americans. People with diabetes have a higher stroke risk and diabetes also is more prevalent among African-Americans.

Fortunately, there are some clear steps that one can take to reduce risk of stroke. The American Heart Association outlines these steps for lowering risk of heart disease and stroke in a program called “Life’s Simple 7.” This program gives detailed instructions to help people learn how to manage their blood pressure, control cholesterol, reduce blood sugar, get active, eat better, lose weight, and stop smoking. For example, there is information about how to be an active partner to your doctor in achieving blood pressure control, including how to select and use inexpensive home blood pressure monitors. Having multiple medical problems greatly enhances a person’s risk, so eliminating even one of them can markedly reduce risk of stroke. With respect to stroke— this old adage certainly is true— prevention is the best medicine!

Now that we know how to prevent a stroke, what is a stroke anyway? It is probably easiest to think about a stroke as an interruption of blood to some part of the brain. Blood is pumped by your heart up through a series of blood vessels in your neck and into your brain. If a blood vessel in the brain gets blocked no blood gets to some part of the brain and we call that an ischemic stroke. If a blood vessel in the brain bursts, we call that a hemorrhagic stroke. In either case, not enough blood gets to some part of the brain. As such, we can simply think of stroke as a ‘blood vessel plumbing problem’ that we want to avoid. Unlike the heart, which does only one thing, which is to pump blood, the brain is responsible for everything we do— talking, walking, moving, seeing, thinking, feeling, speaking. If some part of the brain doesn’t get blood with oxygen and blood sugar, even for a short time, that part of the brain doesn’t work correctly and people experience stroke symptoms.

A useful way to think about stroke symptoms and what to do is the American Heart Association acronym “FAST.”

“F” is for face drooping: Does one side of the face droop? Ask the person to smile to see if it is very uneven.

“A” is for arm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

“S” is for speech difficulty: Is speech slurred? Is the person unable to speak or hard to understand?

“T” is for time to call 911: If someone shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Even transient symptoms are an emergency since they can be warning signs of a severe stroke in the next hours or days. Check the time so you'll know when the first symptoms appeared.

There are now treatments that can reduce stroke severity if given quickly enough. Every minute that the brain does not get blood, millions of brain cells die. Calling 911 is the most effective way to get this treatment.

For more information on the “Life’s Simple 7” program visit www.heart.org.