Stroke risk factors on the rise in Native-Americans

Stroke risk factors such as high blood pressure, diabetes, heart disease and smoking are common and on the rise among Native Americans with clot-caused stroke, according to preliminary research to be presented in Honolulu at the American Stroke Association's International Stroke Conference 2019.

"All of us need to be aware of risk factors like high blood pressure, smoking and diabetes that can lead to stroke. Identifying increases in risk factors in ethnic groups with health and socioeconomic disparities can help us target these risks to reduce the stroke burden going forward," said Dinesh V. Jillella, M.D., lead author of the study and a vascular neurology fellow at the Cleveland Clinic Foundation in Ohio.

It has been previously reported that Native Americans have a higher incidence of stroke than other racial groups in the United States. In this study, researchers used the Cerner nationwide database of electronic health records from 700 hospitals to identify 4,729 Native Americans (46 percent male) diagnosed with ischemic (clot-caused) stroke between 2000 and 2016.

They found that many risk factors were common in those with stroke, including:

• high blood pressure (66.6 percent);
• diabetes (38.8 percent);
• coronary heart disease (23.4 percent);
• smoking (21.6 percent);
• heart failure (12.3 percent);
• atrial fibrillation, an irregular heartbeat (10.5 percent); and
• atrial flutter, an abnormally fast heartbeat (1.4 percent).

When researchers analyzed changes in the risk factors over time, they found that all risk factors, except for diabetes, rose significantly between 2000 and 2016.

"It was alarming to find a significant increase in modifiable risk factors like smoking and high blood pressure. Clinicians should aggressively target modifiable stroke risk factors in the Native American population," Jillella said.

The researchers are currently comparing how common these risk factors are in Native American stroke survivors with those from other racial groups who have a lower incidence of stroke. They are also analyzing the prevalence of risk factors in Native Americans with hemorrhagic or bleeding strokes.

Because this study used an electronic medical record database, it has the advantage of a large sample size, but also the limitation that errors in coding by health professionals may have occurred.

The department of neurology at the University of New Mexico funded this project.