Major CVD Risk Factors Prevalent in US Latinx With History of Stroke

By Linda Carroll

March 05, 2021

(Reuters Health) - In the U.S., less than half of Latinos/Hispanics with a history of stroke or transient ischemic attack (TIA) have healthy blood pressure, cholesterol levels and/or blood sugar levels, raising the risk of future cardiovascular events, a new study finds.

An analysis of data from more than 400 patients with a stroke history revealed that 59% had high blood pressure, 65% had high cholesterol and 39% had diabetes, according to the results published in Stroke.

"A substantial percentage of the Hispanic/Latino adults with a history of stroke have uncontrolled vascular risk factors which put them at high risk of having more strokes with the subsequent risk for disability and death," said study coauthor Dr. Fernando Testai, an associate professor of neurology at the University of Illinois in Chicago. "The majority of the participants were aware that they had these vascular risk factors. The concerning observation is that there was a low percentage of individuals that met the goals for stroke prevention recommended by the American Heart Association and the American Stroke Association," he said in an email.

"As an example, we observed that only 32%-54% of the participants with (hypertension), elevated cholesterol and/or diabetes had these factors under control," Dr. Testai said added. "Also, only 25% were on antiplatelet drugs and cholesterol lowering medications, which are the mainstay of recurrent stroke prevention."

To take a closer look at the prevalence of cardiovascular risk factors and their treatment in Latinos with a history of stroke, Dr. Testai and his colleagues turned to the Hispanic Community Health Study/Study of Latinos, which contains data on 16,415 self-identified Hispanic/Latino adults aged 18 to 74 who were randomly selected from four U.S. urban communities - the Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA - and enrolled between March 2008 and June 2011.

The researchers focused their analysis on 404 participants, 159 of whom were men, who had a self-reported history of stroke/TIA. The prevalence of hypertension, dyslipidemia and diabetes was 59%, 65%, and 39%, respectively. Among those who met the criteria for those diagnoses, the frequency of awareness of these conditions was 90%, 65%, and 83%, respectively. Among those who were aware of their vascular risk factors, the prevalence of controlled hypertension, dyslipidemia, and diabetes was 46%, 32%, and 54%, respectively.

Approximately 46% of the participants were being treated with antithrombotics, 39% were receiving statins, and 26% were on both. Only 38% of those with atrial fibrillation were receiving anticoagulation therapy.

"Our study suggest that the implementation of stroke prevention strategies in Hispanics/Latinos is suboptimal and highlights the need for developing tailored strategies to enhance the access to care of this community," Dr. Testai said.

Dr. Johanna Contreras was not surprised by the findings.

"We've known for many years that Hispanics have a higher risk for cardiovascular risk factors," said Dr. Contreras, director of heart failure at Mount Sinai Health System in New York City. "I think genetics has a role along with environmental factors. Unfortunately, as a group they have lower socioeconomic status and as a culture, this is a group that does not see doctors for preventive medicine. That's engrained. They only consider seeing a doctor when they are sick."

Moreover, Dr. Contreras said, getting patients, especially male patients, to switch to a healthier diet can be challenging. The men rarely cook so, "sometimes I have to call the wife in to manipulate the diet," she added.

The best way to change things is to work with community organizations and/or with the local churches, Dr. Contreras said.

The new study spotlights a growing problem, said Dr. Utibe Essien, an assistant professor of medicine at the University of Pittsburgh School of Medicine.

"Given the increasing rates of chronic cardiovascular risk factors along with the growing rate of Hispanic/Latinx individuals in the U.S. these findings are critical towards achieving health equity," Dr. Essien said in an email. "Understanding the mechanisms through which racial/ethnic disparities persist, from lower rates of disease awareness to under treatment in communities of color will help inform clinicians, researchers, and policymakers developing much-needed interventions to achieve equitable healthcare."

SOURCE: Stroke, online March 4, 2021.