title: Addressing Stroke Risk Factors in Black and White Americans: Findings from the National Health and Nutrition Examination Survey, 2009-2010.
abstract: OBJECTIVE
  Recurrent stroke affects 5%-15% of stroke survivors, is higher among Blacks, and preventable with secondary stroke prevention medications. Our study aimed to examine racial differences in risk factors being addressed (defined as either on active treatment or within guideline levels) among stroke survivors and those at risk for stroke.
  
  
  METHODS
  A cross-sectional study using NHANES 2009-2010 standardized interviews of Whites and Blacks aged ≥18 years. Risk factors were defined as being addressed if: 1) for hypertension, SBP <140, DBP <90 (SBP<130, DBP<80 for diabetics) or using BP-lowering medications; 2) for current smoking, using cessation medications; and 3) for hyperlipidemia, LDL<100 (LDL<70 for stroke survivors) or using lipid-lowering medications. Participants were stratified by stroke history. Prevalence of addressed risk factors was compared by race.
  
  
  RESULTS
  Among 4005 participants (mean age 48, 52% women, 15% Black), 4% reported a history of stroke. Among stroke survivors, there were no statistically significant differences in Blacks and Whites having their hypertension or hyperlipidemia addressed. Among stroke naïve participants, the prevalence of addressed hypertension (P<.01) and hyperlipidemia (P<.01) was lower in Blacks compared with Whites.
  
  
  CONCLUSIONS
  We found that addressed hypertension and hyperlipidemia in stroke naïve participants were significantly lower in Blacks than Whites. Our observations call attention to areas that require further investigation, such as why Black Americans may not be receiving evidence-based pharmacologic therapy for hypertension and hyperlipidemia or why Black Americans are not at goal blood pressure or goal LDL. A better understanding of this information is critical to preventing stroke and other vascular diseases.
authors: Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), University of Alabama at Birmingham.
authors: Karen C
authors: KC
authors: Albright
authors: Department of Neurology, Columbia University.
authors: Amelia K
authors: AK
authors: Boehme
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham.
authors: Rikki M
authors: RM
authors: Tanner
authors: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham.
authors: Justin
authors: J
authors: Blackburn
authors: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham.
authors: George
authors: G
authors: Howard
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham.
authors: Virginia J
authors: VJ
authors: Howard
authors: Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham.
authors: Monika
authors: M
authors: Safford
authors: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham.
authors: T Mark
authors: TM
authors: Beasley
authors: Department of Neurology, School of Medicine, University of Alabama at Birmingham.
authors: Nita
authors: N
authors: Limdi
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology*; D017741:Survivors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: African Americans; Cerebral Infarction; Disparities; Primary Prevention; Secondary Prevention; Stroke