Abstract NS6: Family History of Stroke: Invisibility of a Key Stroke Risk Factor among High Risk African Americans

Background & Purpose: Young to middle aged African Americans (AA) are at greater risk for a first-ever stroke, severe neurologic disability, and stroke-related mortality, than Caucasians of similar age; however, it remains unclear what role a family history of stroke (FHS) plays in promoting adoption of healthier lifestyles in this cohort. The purpose of this study was to explore differences between rural Stroke Belt AA with a FHS (e.g. parent/grandparent/sibling) on modifiable stroke risk factors, knowledge, perceived threat and perceived control of stroke, and exercise behaviors to AA without a FHS. Methods: A cross-sectional study was conducted recruiting AA aged 19-54 from the Black Belt region of Alabama via a mobile health clinic. Participants’ perceptions, knowledge, exercise history/intent, physiologic data, and health history were recorded. Results: Participants (N=66) averaged 43.3+9.4 years, were 71% female, with at least 12 years of school (89%), and unemployed (62%). Common risk factors were insufficient exercise (76%), obesity (59%), hypertension (53%; blood pressure M=145+17.6/88.3+12.9), and cigarette smoking (38%). Participants with a FHS (n=33) did not differ on average number of risk factors compared to those without a FHS (FHS 2.8+1.4 vs. 2.2+1.5; t(64)= 1.73, p=.089), nor did they differ on physiologic data. However, participants with a FHS were more likely to report a history of hypertension (67%) compared to those without a FHS (33%; χ2 =4.93, p <.05). There were no significant differences between groups for knowledge of stroke risk factors, perceived threat and perceived control of stroke, or recent exercise performance, although participants with a FHS (3.4+1.2) had significantly lower future intentions to exercise compared to those without a FHS (3.9+0.8); t(64)=2.45, p<.05). Conclusions: Although FHS is a significant non-modifiable risk factor for stroke and was common in this young to middle-aged AA cohort, FHS did not drive perceived stroke risk, risk factor control, or current/future intentions to exercise. Identification of interventions designed to personalize FHS as a key stroke risk factor, while promoting lifestyle change and self-management, may play an important role in future primary stroke prevention.

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Abstract TP203: Reducing Stroke Burden in Uganda

Stroke ◽

10.1161/str.48.suppl_1.tp203 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mark Kaddumukasa ◽

Jane Nakibuuka ◽

James Kayima ◽

Elly Katabira ◽

Carol Blixen ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Growth Patterns ◽

Warning Signs ◽

Clear Understanding ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Study Participants ◽

Stroke Knowledge

Background: Stroke is a neurological condition with rapidly increasing burden in many low- and middle-income countries. Africa is particularly hard-hit due to rapid population growth, patterns of industrialization, adoption of harmful western diets, and increased prevalence of risk factors such as hypertension and obesity. Reducing stroke risk factors and teaching people to respond to stroke warning signs can prevent stroke and reduce burden. However, being able to address gaps in knowledge and improving both preventative and early-response care requires a clear understanding of practical and potentially modifiable topics. Methods: A cross sectional survey was conducted in urban Mukono district in central Uganda. Through a systematic sampling method, data were gathered from 440 adult participants who were interviewed about selected aspects of stroke knowledge, attitudes and perception, using a pretested structured questionnaire. Results: Of the 440 study participants enrolled for this study nearly 52% correctly reported that stroke involves the brain, while 57% reported that stroke is preventable. Majority of the participants 75.7% reported stress as a contributing factor. Only 45.7% of the study participants reported hypertension as a risk factor. Only two (0.5%) study participants identified cigarette smoking as a stroke risk factor. Of the eighty six study participants with hypertension only 39.5% knew hypertension as a risk factor and only 10.7% knew three or more stroke risk factors. Conclusion: Stroke knowledge is poor in urban Uganda. Individuals with hypertension had poor knowledge regarding stroke in spite their high risk for stroke. Stress and hypertension are the leading perceived risk factors in our settings. While stress is highly reported as a stroke risk factor in this study hypertension is likely a more amenable and practical intervention target.

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Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score

Thrombosis and Haemostasis ◽

10.1160/th15-07-0565 ◽

2015 ◽

Vol 114 (10) ◽

pp. 826-834 ◽

Cited By ~ 70

Author(s):

Flemming Skjøth ◽

Peter Nielsen ◽

Torben Bjerregaard Larsen ◽

Gregory Lip

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Additional Risk Factor ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Long Run ◽

One Year ◽

Net Clinical Benefit

SummaryOral anticoagulation (OAC) to prevent stroke has to be balanced against the potential harm of serious bleeding, especially intracranial haemorrhage (ICH). We determined the net clinical benefit (NCB) balancing effectiveness and safety of no antithrombotic therapy, aspirin and warfarin in AF patients with none or one stroke risk factor. Using Danish registries, we determined NCB using various definitions intrinsic to our cohort (Danish weights at 1 and 5 year follow-up), with risk weights which were derived from the hazard ratio (HR) of death following an event, relative to HR of death after ischaemic stroke. When aspirin was compared to no treatment, NCB was neutral or negative for both risk strata. For warfarin vs no treatment, NCB using Danish weights was neutral where no risk factors were present and using five years follow-up. For one stroke risk factor, NCB was positive for warfarin vs no treatment, for one year and five year follow-up. For warfarin vs aspirin use in patients with no risk factors, NCB was positive with one year follow-up, but neutral with five year follow-up. With one risk factor, NCB was generally positive for warfarin vs aspirin. In conclusion, we show a positive overall advantage (i.e. positive NCB) of effective stroke prevention with OAC, compared to no therapy or aspirin with one additional stroke risk factor, using Danish weights. ‘Low risk’ AF patients with no additional stroke risk factors (i.e. CHA2DS2-VASc 0 in males, 1 in females) do not derive any advantage (neutral or negative NCB) with aspirin, nor with warfarin therapy in the long run.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

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An Examination of Stroke-Related Knowledge in Male Stroke Survivors Living in the South Carolina Stroke Belt

American Journal of Men s Health ◽

10.1177/1557988314531038 ◽

2014 ◽

Vol 8 (6) ◽

pp. 532-537 ◽

Cited By ~ 1

Author(s):

Charles Ellis

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Risk Factor ◽

Racial Differences ◽

Stroke Prevention ◽

Stroke Risk ◽

Stroke Survivors ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Stroke Knowledge

Racial differences have been observed in stroke-related knowledge and knowledge of specific stroke risk factors and stroke prevention practices. Using data from 134 male stroke survivors, racial differences in overall knowledge, risk factor knowledge, and stroke prevention practices were examined using the Stroke Knowledge Test. Knowledge that diabetes doubles ones risk of stroke was present in 48% of the participants, while knowledge of aspirin in the prevention of stroke by stopping blood clot formation was reported in 83% of the participants. Findings indicate participants were knowledgeable that obesity increased risk of stroke (71%) and high blood pressure was the most important stroke risk factor (70%). Participants indicated knowledge that diet, exercise, and controlling blood pressure and cholesterol reduces risk of stroke (86%). In regression models, there were no significant race differences in overall stroke knowledge or the odds of knowledge of information related to stroke risk factors and stroke prevention practices after adjusting for age, education, and marital status. Although stroke-related knowledge did not differ by race, stroke survivors exhibited gaps in stroke knowledge particularly of knowledge of common risk factors. These factors should be considered in approaches to improve stroke-related knowledge in all stroke survivors.

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Stroke-Risk Factors Differ between Rural and Urban Communities: Population Survey in Central Uganda

Neuroepidemiology ◽

10.1159/000381453 ◽

2015 ◽

Vol 44 (3) ◽

pp. 156-165 ◽

Cited By ~ 10

Author(s):

Jane Nakibuuka ◽

Martha Sajatovic ◽

Joaniter Nankabirwa ◽

Anthony J. Furlan ◽

James Kayima ◽

...

Keyword(s):

Risk Factors ◽

Family History ◽

Alcohol Consumption ◽

Stroke Risk ◽

Overweight And Obesity ◽

Stroke Risk Factors ◽

Waist Hip Ratio ◽

Harmful Alcohol ◽

History Of ◽

Family History Of Hypertension

Background: Socioeconomic transition is changing stroke risk factors in Sub-Saharan Africa. This study assessed stroke-risk factors and their associated characteristics in urban and rural Uganda. Methods: We surveyed 5,420 urban and rural participants and assessed the stroke-risk factor prevalence and socio-behavioural characteristics associated with risk factors. Results: Rural participants were older with higher proportions of men and fewer poor compared to urban areas. The most prevalent modifiable stroke-risk factors in all areas were hypertension (27.1% rural and 22.4% urban, p = 0.004), overweight and obesity (22.0% rural and 42% urban, p < 0.0001), and elevated waist hip ratio (25.8% rural and 24.1% urban, p = 0.045). Diabetes, smoking, physical inactivity, harmful alcohol consumption were found in ≤5%. Age, family history of hypertension, and waist hip ratio were associated with hypertension in all, while BMI, HIV were associated with hypertension only in urban dwellers. Sex and family history of hypertension were associated with BMI in all, while age, socio-economic status and diabetes were associated with BMI only in urban dwellers. Conclusions: The prevalence of stroke-risk factors of diabetes, smoking, inactivity and harmful alcohol consumption was rare in Uganda. Rural dwellers belonging to a higher age group tended to be with hypertension and elevated waist hip ratio. Unlike high-income countries, higher socioeconomic status was associated with overweight and obesity.

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Abstract P714: Knowledge of Stroke Warning Signs and Risk Factors in Minnesota Adults

Stroke ◽

10.1161/str.52.suppl_1.p714 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Niloufar N Hadidi ◽

Meghan K Tierney ◽

Jane Claeys ◽

Olga V Gurvich

Keyword(s):

Risk Factors ◽

Family History ◽

Risk Score ◽

Stroke Risk ◽

Lifestyle Changes ◽

Warning Signs ◽

Warning Sign ◽

Cross Sectional Survey ◽

Stroke Risk Factors ◽

History Of

Background: Global Burden of Disease identified stroke as the second leading cause of death worldwide after ischemic heart disease. Many stroke risk factors are preventable with lifestyle changes. A better understanding of the relationship between demographics and knowledge of stroke risk factors and warning signs may help in identifying target populations for preventative stroke education. Purpose: This study aimed to explore 1)knowledge of stroke risk factors and warning signs among Minnesota adults, 2)association between knowledge of risk factors and presence of risk factors and 3)association between the knowledge of warning signs and family history of stroke. Methods: A cross-sectional survey of 207 consenting adults who completed open-ended questionnaires on identifying stroke risk factors and warning signs per American Stroke Association (ASA) was used. Self-reported demographics, medical/family history and lifestyle behaviors data were combined with measured height, weight and blood pressure to provide an individual stroke risk score per the ASA Stroke Risk Score. Results: Most participants(90.3%) correctly identified at least one stroke warning sign, but <1% identified all warning signs (FAST+Walking+Vision). 58.9% identified ≥3 stroke risk factors while only 2.4% identified 6 risk factors. Of the highest ranked stroke risk factors(hypertension, smoking, diabetes, diet, obesity, exercise, age, gender, atrial fibrillation), hypertension and obesity were the most named, correctly identified by 64.3% and 53.1% respectively. Females were slightly more knowledgeable of risk factors(63.9% females vs. 51.8% males) and warning signs(62.3% females vs. 58.8% males). No statistically significant associations were observed between knowledge of risk factors and presence of them, or between family history of stroke and knowledge of stroke warning signs. Conclusion: The findings of this study identified the need for public education of stroke risk factors and warning signs as a critical first step in behavior change. Gender differences in knowledge was slightly different. Other demographic differences was not identified due to study sample homogeneity. Additional efforts should be made to increase sample diversity in future studies.

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Public health campaigns and their effect on stroke knowledge in a high-risk urban population: A five-year study

Vascular ◽

10.1177/1708538117691879 ◽

2017 ◽

Vol 25 (5) ◽

pp. 497-503 ◽

Cited By ~ 5

Author(s):

Maged M Metias ◽

Naomi Eisenberg ◽

Michael D Clemente ◽

Elizabeth M Wooster ◽

Andrew D Dueck ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Stroke Risk ◽

High Risk Population ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Awareness Campaigns ◽

Stroke Symptom ◽

Stroke Knowledge

Background The level of knowledge of stroke risk factors and stroke symptoms within a population may determine their ability to recognize and ultimately react to a stroke. Independent agencies have addressed this through extensive awareness campaigns. The aim of this study was to determine the change in baseline knowledge of stroke risk factors, symptoms, and source of stroke knowledge in a high-risk Toronto population between 2010 and 2015. Methods Questionnaires were distributed to adults presenting to cardiovascular clinics at the University of Toronto in Toronto, Canada. In 2010 and 2015, a total of 207 and 818 individuals, respectively, participated in the study. Participants were identified as stroke literate if they identified (1) at least one stroke risk factor and (2) at least one stroke symptom. Results A total of 198 (95.6%) and 791 (96.7%) participants, respectively, completed the questionnaire in 2010 and 2015. The most frequently identified risk factors for stroke in 2010 and 2015 were, respectively, smoking (58.1%) and hypertension (49.0%). The most common stroke symptom identified was trouble speaking (56.6%) in 2010 and weakness, numbness or paralysis (67.1%) in 2015. Approximately equal percentages of respondents were able to identify ≥1 risk factor (80.3% vs. 83.1%, p = 0.34) and ≥1 symptom (90.9% vs. 88.7%, p = 0.38). Overall, the proportion of respondents who were able to correctly list ≥1 stroke risk factors and stroke symptoms was similar in both groups.(76.8% vs. 75.5%, p = 0.70). The most commonly reported stroke information resource was television (61.1% vs. 67.6%, p = 0.09). Conclusion Stroke literacy has remained stable in this selected high-risk population despite large investments in public campaigns over recent years. However, the baseline remains high over the study period. Evaluation of previous campaigns and development of targeted advertisements using more commonly used media sources offer opportunities to enhance education.

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Association between Family History of Stroke and Stroke Risk: A Community Survey

Western Journal of Nursing Research ◽

10.1177/0193945920957935 ◽

2020 ◽

Vol 42 (12) ◽

pp. 1174-1181

Author(s):

Jane Claeys ◽

Olga Gurvich ◽

Niloufar Niakosari Hadidi

Keyword(s):

Risk Factor ◽

Family History ◽

High Risk ◽

Risk Score ◽

Stroke Risk ◽

The United States ◽

Primary Study ◽

Cross Sectional Survey ◽

Stroke Risk Factor ◽

History Of

Approximately 20% of the annual 795,000 stroke occurrences in the United States are fatal, and survivors face high-risk of long-term disability. The purpose of this secondary analysis of a cross-sectional survey data was to explore the association between individuals’ family history of stroke and their stroke risk among Minnesota adults attending the State Fair. The primary study sample (n=207) completed a nine-part survey addressing medical history, stroke risk factor knowledge, and the American Stroke Association stroke risk score. Analysis used descriptive summaries and McNemar’s Chi-square test. McNemar’s test indicated a significant association between family history of stroke and an individual’s stroke risk score ( χ2=38.09, p<.001, (n=194)). Of those with and without family history of stroke, 87.1% and 95.5% correctly identified at least one stroke risk factor, respectively. Implications of this secondary data analysis is for nurses to target high-risk populations using primary prevention strategies to reduce stroke occurrence.

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Knowledge of Stroke Risk Factors and Signs in Parakou, a Northern City of Benin in West Africa

Cerebrovascular Diseases ◽

10.1159/000512715 ◽

2021 ◽

pp. 1-6

Author(s):

Mendinatou Agbetou Houessou ◽

Hospice Hountada ◽

Bertrand Yahouédéou ◽

Blaise Choki ◽

Oyéné Kossi ◽

...

Keyword(s):

Risk Factors ◽

Stroke Risk ◽

Warning Signs ◽

Stroke Risk Factor ◽

Level Of Education ◽

Stroke Risk Factors ◽

Awareness Campaigns ◽

Open Questions ◽

History Of ◽

High Level

Introduction: We aimed to determine knowledge of stroke risk factors and signs in an urban population of northern Benin. Methods: A door-to-door purposeful sampling survey was conducted in resident population (age ≥15 years) of the district of Titirou in the city of Parakou (N = 255,478) in Benin between March 15 and July 15, 2016. In-person interviews were conducted with data collection on structured questionnaires with close and open questions, according to standard definitions. Multivariable logistic regression was used to assess predictors of good knowledge, defined by provision of a correct response in pre-defined set of questions on stroke risk factors and warning signs. Results: Of 4,671 participants (mean age 27.7 ± 12.9 years; females 50.6%), only 404 (8.6%) knew at least 1 stroke risk factor. Knowledge level of stroke risk factors (odds ratio, 95% confidence interval) was related to age (1.37, 1.27–1.48), level of education (2.54, 1.73–3.72), and family history of stroke (3.01, 2.08–4.26). Only 230 (4.9%) were able to cite at least 1 stroke symptom, and this knowledge was great with increasing age (1.04, 1.02–1.06), family (3.63, 2.41–5.49) and personal history of stroke (3.71, 1.86–7.42), and high level of education (4.35, 2.68–7.07). Conclusion: Knowledge of stroke risk factors and signs is low in northern Benin. Greater public education and awareness campaigns are required to address the burden of stroke.

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947. Stroke demographics and risk factor profile in HIV infected individuals in Florida

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1133 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S506-S506

Author(s):

Folusakin Ayoade ◽

Dushyantha Jayaweera

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Clinical Research ◽

Stroke Risk ◽

Research Network ◽

Categorical Variables ◽

People Living With Hiv ◽

Risk Factor Profile ◽

Stroke Risk Factors ◽

Living With Hiv

Abstract Background The risk of ischemic stroke (IS) is known to be higher in people living with HIV (PLWH) than uninfected controls. However, information about the demographics and risk factors for hemorrhagic stroke (HS) in PLWH is scant. Specifically, very little is known about the differences in the stroke risk factors between HS and IS in PLWH. The goal of this study was to determine the demographics and risk factor differences between HS and IS in PLWH. Methods We retrospectively analyzed the demographic and clinical data of PLWH in OneFlorida (1FL) Clinical Research Consortium from October 2015 to December 2018. 1FL is a large statewide clinical research network and database which contains health information of over 15 million patients, 1240 clinical practices, and 22 hospitals. We compared HS and IS based on documented ICD 9 and 10 diagnostic codes and extracted information about sociodemographic data, traditional stroke risk factors, Charlson comorbidity scores, habits, HIV factors, diagnostic modalities and medications. Statistical significance was determined using 2-sample T-test for continuous variables and adjusted Pearson chi square for categorical variables. Odds ratio (OR) and 95% confidence intervals (CI) between groups were compared. Results Overall, from 1FL sample of 13986 people living with HIV, 574 subjects had strokes during the study period. The rate of any stroke was 18.2/1000 person-years (PYRS). The rate of IS was 10.8/1000 PYRS while the rate of HS was 3.7/1000 PYRS, corresponding to 25.4% HS of all strokes in the study. Table 1 summarizes the pertinent demographic and risk factors for HS and IS in PLWH in the study. Table 1: Summary of pertinent demographic and risk factors for hemorrhagic and ischemic strokes in people living with HIV from One Florida database Conclusion In this large Floridian health database, demographics and risk factor profile differs between HS and IS in PLWH. Younger age group is associated with HS than IS. However, hypertension, hyperlipidemia and coronary artery disease are more likely to contribute to IS than HS in PLWH. Further research is needed to better understand the interplay between known and yet unidentified risk factors that may be contributing to HS and IS in PLWH. Disclosures All Authors: No reported disclosures

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Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽

10.1161/str.45.suppl_1.tp136 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

George Howard ◽

Mary Cushman ◽

Maciej Banach ◽

Brett M Kissela ◽

David C Goff ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Multivariable Analysis ◽

The Elderly ◽

Stroke Risk Factors ◽

Age Related ◽

Increased Risk ◽

The Impact ◽

Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

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