05 Mar Cultural Factors May Account for Lack of Preventive Measures in LatinX Stroke Patients
MedicalResearch.com Interview with:
Fernando D Testai, MD, PhD, FAHA
Associate Professor of Neurology and Rehabilitation
Stroke Medical Director
University of Illinois Health
MedicalResearch.com: What is the background for this study?
Response: Stroke constitutes a leading cause of disability and mortality in the United States. Large observational studies have shown that up to 90% of the strokes are caused by modifiable vascular risk factors, including hypertension, diabetes mellitus, and several others. In addition, previous history of stroke is one of the most powerful predictors of recurrent stroke. Thus, controlling vascular risk factors in patients with stroke is of paramount importance. To this end, the American Heart Association and the American Stroke Association have developed specific targets for blood pressure, glycemic, and cholesterol levels.
MedicalResearch.com: What are the main findings?
Response: In our study we investigated the rate of control of hypertension, diabetes mellitus and hypercholesterolemia in Hispanic/Latino adults with previous history of stroke. The majority of the participants were aware that they had vascular risk factors for stroke. However, 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. As an example, we observed that only 32-54% of the participants with HTN, elevated cholesterol and/or diabetes had these factors under control. Also, only 25% were on antiplatelet drugs and cholesterol lowering medications, which are the mainstay of recurrent stroke prevention.
Several factors may influence the rate of poorly control vascular risk factors observed in our study. Some of them may be cultural. In a science advisory statement, the American Heart Association highlights different cultural factors that may influence cardiovascular and cerebrovascular health promotion in Hispanic/Latino adults. These include nutritional behaviors, degree of acculturation, familial support, believes (such as preference for using alternative medicines such as herbs), and religious values. However, there are also structural factors which are engrained in our society. These include access to medical care (which is often associated with employment and access to insurance), language barrier, distrust and difficulty negotiating the health care system, low education and literacy attainment, psychosocial stressors, socioeconomic status, and many others.
MedicalResearch.com: What should readers take away from your report?
Response: In our study, we also made some interesting observations. Lack of vascular risk factor control was associated with older age. Also, participants who lived in the United States had poorer diabetes control. We speculate that this may be related to the process of acculturation or Americanization which exposes Hispanic/Latino individuals to a diet that is richer in fats. Finally, we observed that patients without insurance were more likely to have elevated cholesterol levels, which suggests a financial component.
There are several take home message that one can take from our study. The first one is that the medical community has to be attentive to the needs of Hispanics/Latino patients who often encounter unique challenges. We have to educate our patients and make sure that we look beyond prescribing refills. Interventions have to be tailored to each individual and each community. But it is equally important for patients to have an active role the promotion of their own health. Patients have to know their own numbers and the expected goals. And if the numbers are not at goal, doctors and patients whould work together in the development of an actionable plan. However, adherence to medications has to be accompanied by the adoption of healthy habits. These include reducing the consumption of salt, frequent exercise, adoption of a healthy diet, watching your weight, etc. An alarming observation is that the rate of obesity in children aged 6-11 years is 25% among Hispanics/Latinos versus 14% among whites. Thus, lifestyles should be implemented as early as possible in life, as the best way to prevent a recurrent stroke is by preventing the first-ever stroke.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our next challenge is to identify in the Hispanic community the presence of Social Determinants of Health that may influence the behaviors and attitudes in patients with stroke.
I don’t have conflict of interest of financial or ties to companies to disclose in relation to this study
Stroke Risk Factor Status and Use of Stroke Prevention Medications Among Hispanic/Latino Adults in HCHS/SOL
Fang Bai, MD, MSPH, Jingsong Chen, PhD, Dilip PandeyMD, PhD, Ramon Durazo-ArvizuPhD, Gregory A. Talavera, MD, MPH, Matthew A. Allison, MD, MPH, Krista M. Perreira, PhD, Neil Schneiderman, PhD, Melanie W. Sutherland, PhD, Jianwen Cai, PhD, Martha L. DaviglusMD, PhD, Fernando D. TestaiMD, PhD
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