According to the Centers for Disease Control and Prevention (CDC), a person in the United States dies of a stroke every 3 minutes and 14 seconds. Strokes are not only a leading cause of death in the United States, but also the leading cause of long-term disability.
The risk of stroke varies with race and ethnicity, with non-Hispanic Black Americans experiencing the highest rates of death from strokes. While risk typically increases with age, young Black Americans are experiencing higher rates of strokes and are nearly four times more likely than white young adults to suffer from a stroke. Black Americans are also more likely to be limited in their physical capabilities after suffering from a stroke.
These increased risks are due to multiple factors, including social determinants of health (SDOH), such as access to care and underlying health conditions like hypertension. Black patients have higher levels of conditions like blood pressure, cholesterol, and stress, all of which can increase stroke risk.
Beyond treatment, providers need to support their patients in overall stroke prevention tactics, such as managing health factors and conditions like blood pressure, weight, diabetes, sleep, smoking, and stress. Educating patients is a vital step in helping them to decrease the risk of stroke.
For Black Americans, the risk of a first stroke is doubled compared to that of white adults. They are also 60 percent more likely than white individuals to suffer from a recurrent stroke within two years. These higher risks are due to multiple factors, including the prevalence of key health risk factors, social determinants, and racism in the medical industry.
Black Americans are more likely to live with key risk factors of strokes, including hypertension, diabetes, sickle cell anemia, high cholesterol, and obesity. Over 50 percent of Black adults have high blood pressure, as well as a higher likelihood of diabetes, both of which can contribute to stroke risk. They are also 28 percent more likely to suffer from obesity.
Due to historically racist systems, Black Americans are less likely to have access to quality education, healthcare, safe housing, and other social determinants of health. They also have higher exposure to poverty, food insecurity, and pollution, all of which can contribute to stroke risk.
Chronic stress can not only increase the risk of high blood pressure, but also the risk of stroke. It is well-documented that Black Americans are more likely to experience chronic stress, both within and outside of the medical system.
For providers, this means supporting Black patients by facilitating stroke prevention as early as possible. One of the vital steps for stroke prevention is to ensure routine visits and check-ins. This includes open communication about medical conditions, such as high blood pressure or diabetes, and how to manage them appropriately.
Providers can work to normalize conversations about risk, even with younger populations. Young Black Americans are four times more likely to experience a stroke than their white counterparts, so these conversations should be facilitated throughout a patient’s lifetime.
Providers need to be transparent with patients about their risk factors, including blood pressure, cholesterol, and A1C levels. This means using language patients can understand, avoiding medical jargon, and ensuring they clearly understand their health status. Providers can work with patients to set actionable goals to reduce stroke risk, such as weight loss and diabetes management.
The signs of a stroke can be summarized in the F.A.S.T. acronym:
Some experts include “B.E.” at the beginning of the acronym to denote ‘Balance loss’ and ‘Eyesight changes’.
For providers, you can ensure your patients know the FAST acronym and corresponding symptoms by providing sources. This includes handouts, regular patient portal messages, and follow-up contact and reminders via text or email. The better your patients can understand the warning signs of a stroke, the better they can call for help and advocate for themselves and their loved ones.
Patients should understand that it is imperative to take immediate action if they or someone around them is experiencing these common stroke symptoms. They can ask the person to smile to check for face drooping, raise their arms to check for arm weakness, and say basic sentences to assess speech. If someone is experiencing these three symptoms, tell your patients it’s time to call 911.
One of the main strategies for stroke prevention is to control blood pressure. Patients should be aware of silent hypertension, or consistently high blood pressure, as this is the most modifiable risk factor for premature cardiovascular disease.
Providers should educate patients on monitoring their blood pressure at home and emphasize the importance of adhering to their prescribed medication regimen.
When it comes to supporting their patients, providers can help by promoting education for realistic lifestyle changes that can help reduce the risk of stroke. This includes encouraging physical activity and smoking cessation, as well as sharing nutritional strategies, such as the Mediterranean diet, which is rich in healthy fats and has been linked to reduced stroke risk. Providers can also assist patients with other lifestyle changes, including sleep and stress management.
While providers can improve support for Black patients when it comes to managing lifestyle choices and reducing the overall risk of stroke, there is only so much in control of the patient themselves. Black individuals continue to experience barriers to care, including systematic racism, insurance costs, stigma, and medical distrust.
Providers can make a difference by giving their patients practical, respectful, and consistent health education and advice. Health education is a vital factor for stroke patients. The more a patient has the opportunity to make informed decisions for their own body, the better their outcome can be.
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