ASIAN Americans were more likely than whites to experience a severe ischemic stroke, according to preliminary research presented on Thursday, January 25 at the American Heart Association/American Stroke Association (AHA/ASA)’s International Stroke Conference (ISC) 2018.
The study was the largest analysis of functional and clinical outcomes for Asian American acute ischemic stroke patients — an ischemic stroke occurs when an obstruction prevents blood supply to the brain.
Clinical and functional outcomes from than 1.77 million patients (3.6 percent Asian American, 96.4 percent white) were reviewed from 2,171 hospitals that participated in an AHA/ASA in-hospital program called “Get With the Guidelines-Stroke” from 2004 to 2016.
“Asian Americans may have a distinctive pathophysiologic profile of ischemic stroke than whites,” said Sarah Song, M.D., Ph.D., M.P.H. She is the study author and assistant professor of cerebrovascular disease at Rush University Medical Center’s Department of Neurology in Chicago, Illinois.
Added Song, “Regardless, this study highlights the need for more focused research, improved stroke prevention and possibly different treatment strategies for Asian Americans.”
The study found that compared to whites, Asian Americans were often associated with: poorer functional recovery; receiving the clot-busting drug tissue plasminogen activator (tPA) less frequently, which can improve the chances of recovering from a stroke; and more serious and bleeding complications with tPA, despite receiving it quickly.
A positive finding from the research was that stroke care for both white and Asian Americans have seen some improvement over time.
“Looking from 2004 to 2016, our study shows that overall, patients with acute ischemic stroke are recovering more, and they are receiving more IV tPA, with less complications and better post-stroke care. This likely has to do with an overall improvement in stroke quality and highly effective stroke systems of care. However, Asian Americans and whites had nuanced differences over time; for example, only whites had a decrease in trend in stroke severity, while Asian Americans had a greater increase in timely IV tPA administration,” said Song.
But not much attention has been given to stroke and stroke care among Asian American subgroups which is something researchers are acknowledging as a limitation.
“There’s different groups from people from China, from Japan, from Korea, from Vietnam, and other countries, so that’s one piece of the puzzle that we don’t know yet,” said ASA spokesperson, Philip B. Gorelick, M.D., MPH.
“Even among Asian Americans, the various minority populations differ in so many ways. Vietnamese people are not the same as Korean, who are not the same as Japanese or South Asian groups. Aside from differences in language, differences in stroke risk factors, diet and lifestyle, and other cultural factors, make compiling all Asian-American groups into single group problematic,” said Song.
But the study was a good first step, she added. “This information gives us the urgency and the credibility to do more research in Asian Americans, who have historically been understudies in the stroke and cardiovascular literature.”
Cardiovascular disease (CVD) — a risk factor for stroke — has been found to be a leading cause of death among Filipino Americans, according to what few studies have been made.
An AHA advisory on cardiovascular disease from 2010 cited data from the National Health Interview Survey that reported hypertension rates being higher among Filipinos than in other Asian American subgroups.
The AHA and ASA recommend seven simple steps to avoiding stroke, and other brain health-related conditions such as dementia or memory loss.
The steps collectively labeled “Life’s Simple 7” are the same for maintaining cardiovascular health and are to: stop smoking, get active, eat better, lose weight, reduce blood sugar, reduce blood pressure, and control cholesterol.
Unfortunately, researchers revealed at the ISC that less than one in 100 stroke survivors are meeting the recommended goals. Out of a nationally representative sample of 67,514 U.S. adults, 1,597 had prior strokes and had data for all seven measures. Furthermore, fewer than one in five stroke survivors met at least four of the measures during the study period, according to researchers.
“These measures have one unique thing in common: any person can make these changes, the steps are not expensive to take and even modest improvements to your health will make a big difference,” says AHA. (Rae Ann Varona / AJPress)