Home Medizin Schlaganfallrisiko bei schwarzen Amerikanern: Fragen und Antworten von Experten

Schlaganfallrisiko bei schwarzen Amerikanern: Fragen und Antworten von Experten

von NFI Redaktion

Black people in the US are more likely to suffer a stroke than White, Hispanic, American Indian, or Asian individuals – and the outcomes are worse. The likelihood of dying from a stroke is three to four times higher for Black Americans compared to White Americans.

The risk of experiencing a stroke is influenced by many factors, including social determinants. Dr. Eseosa Ighodaro, MD, PhD, a stroke fellow at Emory University/Grady Hospital in Atlanta, is working on initiatives to address racial disparities in neurological health, particularly in stroke outcomes. She founded Ziengbe, a non-profit organization aiming to eliminate neurological health disparities faced by the Black community through education and empowerment.

Here, Ighodaro answers questions about stroke risk in Black Americans, including symptoms everyone should be aware of, what to do if these symptoms occur, and how to reduce the risk of stroke.

It is important to know the signs and symptoms of a stroke. Remember the acronym FAST, which stands for:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call

Other signs of a stroke may include numbness and loss of vision. If you or someone you know experiences any of these signs and symptoms, time is of the essence. Do not wait: go to the nearest emergency room immediately.

And when you arrive, be prepared to advocate for yourself or your loved one. Say these words: „I am concerned that I am having a stroke.“

Black patients often experience delays in diagnosis and treatment in a hospital with stroke symptoms, leading to worse outcomes. We also know that Black individuals are significantly less likely to receive the gold standard treatments for strokes, such as the clot-busting drug tPA and mechanical thrombectomy, a technique for removing blood clots from the brain.

These interventions are time-sensitive. We can administer clot-busting drugs only within 4.5 hours [after symptoms start] and perform a mechanical thrombectomy only within 24 hours. So if you have a drooping face or numbness and weakness on one side of the body, do not wait at home thinking it will go away.

There are various reasons behind this. When discussing risk factors for strokes, there are two main categories: ones we can modify and ones we cannot. Non-modifiable risk factors include our age, gender at birth, race/ethnicity, and family history of strokes. Modifiable risk factors include poor diet, lack of exercise, obesity, diabetes, high blood pressure, smoking, and high cholesterol.

We know that Black Americans are more burdened by these modifiable risk factors overall. Over half of Black adults have high blood pressure, Black Americans are more likely to have diabetes than Whites, and almost 25% of Blacks have high LDL cholesterol levels, the „bad“ type of cholesterol.

When treating a patient in my stroke clinic, my primary focus is on these modifiable risk factors to either prevent a first stroke or reduce the risk of a second stroke. This involves providing the individual with appropriate medications and interventions, such as blood pressure drugs, smoking cessation programs, and connecting individuals with diabetes to a primary care physician or endocrinologist to ensure they are well managed. We know that the Mediterranean diet has been proven to improve stroke outcomes, so I typically also connect these patients with a nutritionist to help them sustainably change their eating habits.

However, this is not the whole picture. Studies have shown that even when we control these modifiable and non-modifiable risk factors, we still observe significant racial disparities in stroke outcomes, likely caused by other social determinants of health.

Social determinants of health are variables that are not medical but still play a role in our health. These include things like socioeconomic status, education level, language barriers, housing and food insecurity, access to safe and healthy spaces for physical activity, and of course, access to healthcare, hospitals, and pharmacies. In the US, some states may have only one comprehensive stroke center, while others may have 15. People living in a state with only one comprehensive stroke center, which could be 150 or 200 miles away, do not have the same access to advanced stroke care as someone living here in Atlanta.

All these factors can influence the stroke risk and outcomes for individuals who have suffered a stroke. For example, data from a crucial stroke disparities study, Reasons for Geographic and Racial Differences in Stroke (REGARDS), showed that individuals with three or more social determinants of health risk factors had nearly two and a half times higher risk of experiencing a stroke than those without such risk factors.

And a study published in 2023 found that „redlining“ – the historical practice of discriminatory housing policies that still affect Black communities today – is associated with an increased risk of stroke beyond other social determinants of health.

This is something we are still trying to measure and quantify: How does simply being Black in America and the stress that comes with the everyday experiences of racism and microaggressions over a lifetime negatively impact the body, including the risk of stroke?

We know that „allostatic load“ – the wear and tear on the body that accumulates when a person is exposed to chronic stress – contributes to worse health outcomes. And a study published in 2022 found that allostatic load predicted mental function scores in Black stroke patients but not in White or Hispanic patients, indicating that these stressors could be responsible for some of the racial disparities in stroke outcomes. We need to better understand this.

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