scholarly journals Racial differences in statin adherence following hospital discharge for ischemic stroke

Neurology ◽  
2017 ◽  
Vol 88 (19) ◽  
pp. 1839-1848 ◽  
Author(s):  
Karen C. Albright ◽  
Hong Zhao ◽  
Justin Blackburn ◽  
Nita A. Limdi ◽  
T. Mark Beasley ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Discharge ◽  
Racial Differences ◽  
Low Income ◽  
Carotid Artery Disease ◽  
Adjusted Relative Risk ◽  
Black Adults ◽  
Black And White ◽  
History Of ◽  
White Adults

Objective:To compare nonadherence to statins in older black and white adults following an ischemic stroke.Methods:We studied black and white adults ≥66 years of age with Medicare fee-for-service insurance coverage hospitalized for ischemic stroke from 2007 to 2012 who filled a statin prescription within 30 days following discharge. Nonadherence was defined as a proportion of days covered <80% in the 365 days following hospital discharge. In addition, we evaluated factors associated with nonadherence for white and black participants separately.Results:Overall 2,763 beneficiaries met the inclusion criteria (13.5% black). Black adults were more likely than white adults to be nonadherent (49.7% vs 41.5%) even after adjustment for demographics, receipt of a low-income subsidy, and baseline comorbidities (adjusted relative risk [RR] 1.14, 95% confidence interval [CI] 1.01–1.29). Among white adults, receipt of a low-income subsidy (adjusted RR 1.13, 95% CI 1.02–1.26), history of coronary heart disease (adjusted RR 1.15, 95% CI 1.01–1.30), and discharge directly home following stroke hospitalization (adjusted RR 1.26, 95% CI 1.10–1.44) were associated with a higher risk of nonadherence. Among black adults, a 1-unit increase in the Charlson comorbidity index (adjusted RR 1.04, 95% CI 1.01–1.09), history of carotid artery disease (adjusted RR 2.38, 95% CI 1.08–5.25), and hospitalization during the 365 days prior to the index stroke (adjusted RR 1.34, 95% CI 1.01–1.78) were associated with nonadherence.Conclusions:Compared with white adults, black adults were more likely to be nonadherent to statins following hospitalization for ischemic stroke.

Abstract MP02: N-Terminal Pro-B-type Natriuretic Peptide and Risk of Stroke in Those With and Without Cerebrovascular Disease: The REGARDS Cohort

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Kara Landry ◽  
Suzanne Judd ◽  
Dawn Kleindorfer ◽  
George Howard ◽  
Virginia Howard ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Racial Differences ◽  
Natriuretic Peptide ◽  
Stroke Recurrence ◽  
Black And White ◽  
Hazard Ratios ◽  
History Of ◽  
Ischemic Attack ◽  
Prior Stroke

Background: N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), a commonly used marker of cardiac function, is associated with presence of stroke symptoms and is a strong risk factor for future atrial fibrillation, stroke and mortality. Little data are available on the association between NT-pro-BNP levels and stroke recurrence. Objective: We studied the relationship between NT-proBNP with the risk of future ischemic stroke across a spectrum of pre-existing cerebrovascular conditions, ranging from history of stroke symptoms, to prior transient ischemic attack (TIA), to prior stroke. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans age 45 years and older in 2003-14. Among a case-cohort study sample including 1109 stroke cases and a 4311-person cohort random sample, we calculated hazard ratios of future ischemic stroke by baseline NT-proBNP stratified by presence of prior cerebrovascular conditions. Results: In the cohort sample, there were 3056 participants without any history of cerebrovascular disease, 738 with prior stroke symptoms, 196 with history of TIA and 338 with history of prior stroke. In a fully adjusted model, elevated NT-proBNP was associated with risk of stroke in participants without a pre-existing cerebrovascular condition (HR 2.32, 95% CI 1.84, 2.94), and in participants with a history of stroke symptoms (HR 1.67 95% CI 1.01, 2.78) or TIA (HR 2.66, 95% CI 1.00, 7.04), but not among those with prior stroke (HR 1.26, 95% CI 0.71, 2.21). Conclusions: These findings further support the potential for NT-proBNP testing to identify patients who are at highest risk for future stroke, although not in those with prior stroke.

scholarly journals Neural control of cardiovascular function in black adults: implications for racial differences in autonomic regulation

2020 ◽  
Vol 318 (2) ◽  
pp. R234-R244 ◽  
Author(s):  
Rachel C. Drew ◽  
Nisha Charkoudian ◽  
Jeanie Park
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Racial Differences ◽  
Neural Control ◽  
Cardiovascular Function ◽  
Black Adults ◽  
Black And White ◽  
Increased Risk ◽  
White Adults

Black adults are at increased risk for developing hypertension and cardiovascular and chronic kidney disease and have greater associated morbidity/mortality than white adults who are otherwise demographically similar. Despite the key role of the autonomic nervous system in the regulation of cardiovascular function, the mechanistic contributions of sympathetic nerves to racial differences in cardiovascular dysfunction and disease remain poorly understood. In this review, we present an update and synthesis of current understanding regarding the roles of autonomic neural mechanisms in normal and pathophysiological cardiovascular control in black and white adults. At rest, many hemodynamic and autonomic variables, including blood pressure, cardiac output, and sympathetic nerve activity, are similar in healthy black and white adults. However, resting sympathetic vascular transduction and carotid baroreflex responses are altered in ways that tend to promote increased vasoconstriction and higher blood pressure, even in healthy, normotensive black adults. Acute sympathoexcitatory maneuvers, including exercise and cold pressor test, often result in augmented sympathetic and hemodynamic responses in healthy black adults. Clinically, although mechanistic evidence is scarce in this area, existing data support the idea that excessive sympathetic activation and/or transduction into peripheral vasoconstriction contribute importantly to the pathophysiology of hypertension and chronic kidney disease in black compared with white adults. Important areas for future work include more detailed study of sympathetic and hemodynamic reactivity to exercise and other stressors in male and female black adults and, particularly, sympathetic control of renal function, an important area of clinical concern in black patients.

scholarly journals Susceptibility to Scams in Older Black and White Adults

2021 ◽  
Vol 12 ◽  
Author(s):  
S. Duke Han ◽  
Lisa L. Barnes ◽  
Sue Leurgans ◽  
Lei Yu ◽  
Christopher C. Stewart ◽  
...  
Keyword(s):  
Racial Differences ◽  
Research Study ◽  
Race Differences ◽  
Black Adults ◽  
Aging Research ◽  
Association Analyses ◽  
Affective Factors ◽  
Black And White ◽  
Global Cognition ◽  
White Adults

Previous reports on racial differences in scam susceptibility have yielded mixed findings, and few studies have examined reasons for any observed race differences. Older Black and White participants without dementia (N = 592) from the Minority Aging Research Study and the Rush Memory and Aging Project who completed a susceptibility to scam questionnaire and other measures were matched according to age, education, sex, and global cognition using Mahalanobis distance. In adjusted models, older Black adults were less susceptible to scams than older White adults (Beta = −0.2496, SE = 0.0649, p = 0.0001). Contextual factors did not mediate and affective factors did not moderate this association. Analyses of specific items revealed Black adults had greater knowledge of scam targeting of older adults and were less likely to pick up the phone for unidentified callers. Older Black adults are less susceptible to scams than demographically-matched older White adults, although the reasons remain unknown.

Abstract MP09: Black-White Differences in the Association Between Sleep Duration and Incident Stroke: The REGARDS Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Megan E Petrov ◽  
George Howard ◽  
Michael A Grandner ◽  
Dawn Kleindorfer ◽  
Jennifer R Molano ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Sleep Apnea ◽  
Racial Differences ◽  
Sleep Duration ◽  
Left Ventricular ◽  
Black And White ◽  
Increased Risk ◽  
History Of ◽  
Blacks And Whites ◽  
White Adults

Introduction: Short and long sleep durations are associated with incident stroke. Few studies have investigated these associations by race despite prevalent inequities in stroke between non-Hispanic black and white adults. The aim of this study was to investigate the relationship between sleep duration and incident stroke in a US cohort of blacks and whites. Methods: Within the REasons for Geographic And Racial Differences in Stroke study, 15,941 black and white adults (≥45yrs) with no history of stroke or sleep apnea were studied. Participants self-reported their habitual sleep duration. Suspected stroke events were identified every 6 months, and associated medical records were retrieved and physician adjudicated. Proportional hazards analysis was used to estimate hazard ratios for incident stroke associated with sleep duration (<6, 6.0-6.9, 7.0-7.9, 8.0-8.9[reference group], 9+hrs) controlling for sociodemographics, stroke risk factors, and depressive symptoms. Results: At baseline, 11.2% of the sample was very short sleepers (<6hrs) and 6.7% were long sleepers (9+hrs). Over an average follow-up of 4.7 ± 1.4 years, 321 stroke events occurred (blacks=114; whites=207). After adjustment, shorter sleep duration was associated with increased risk for incident stroke (6.0-6.9hr: OR=1.41, 95%CI 1.02-1.94; 7.0-7.9hr: OR=1.36, 95%CI 1.01-1.83). The interaction between sleep duration and race was significant ( p =0.02). In stratified analyses, shorter sleep duration was associated with increased risk for stroke in whites but not blacks (see table). Discussion: Among middle-aged to older, white adults with no history of stroke or sleep apnea, shorter sleep duration was associated with increased risk for stroke. There was no association among blacks. Resilience to insufficient sleep as a risk factor for stroke may differ for blacks and whites. Adjusted for age, sex, education, income, depressive symptoms, hypertension, diabetes, atrial fibrillation, left ventricular hypertrophy, heart disease, and smoking status

scholarly journals The Role of Stressful Childhood Experiences in Shaping Later-Life Memory Loss Among Black and White U.S. Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 296-296
Author(s):  
Caroline Hartnett
Keyword(s):  
Cognitive Decline ◽  
Memory Loss ◽  
Later Life ◽  
Behavioral Risk ◽  
Black Adults ◽  
Childhood Experiences ◽  
White Children ◽  
Black And White ◽  
Stressful Experiences ◽  
White Adults

Abstract Cognitive decline common in the U.S. and greatly impacts quality of life, both for those who experience it and for those who care for them. Black Americans experience higher burdens of cognitive decline but the mechanisms underlying this disparity have not been fully elucidated. Stress experienced in early life is a promising explanatory factor, since stress and cognition are linked, childhood stressors been shown to have a range of negative implications later in life, and Black children experience more childhood stressors than White children, on average. In this paper, we use data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine whether stressful experiences in childhood help explain Black-White disparities in memory loss. These data were available for 5 state-years between 2011 and 2017 (n=11,708). Preliminary results indicate that, while stressful childhood experiences are strongly associated with memory loss, stressful experiences do not mediate the association between race and memory loss. However, race does appear to moderate the association between stressful childhood experiences and memory loss. Specifically, stressful experiences are associated with a higher likelihood of memory loss for Black adults compared to White adults.In addition, there seem to be some noteworthy patterns across different types of experiences (i.e. parental drinking may predict later memory loss more strongly for Black adults than White adults, but parental hitting may predict memory loss more strongly for White adults than Black adults).

Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Tan Xu ◽  
Yonghong Zhang ◽  
Yingxian Sun ◽  
Chung-Shiuan Chen ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Hospital Discharge ◽  
Odds Ratio ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Antihypertensive Medications ◽  
History Of

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

scholarly journals Why are black adults over-represented among individuals who have experienced lifetime homelessness? Oaxaca-Blinder decomposition analysis of homelessness among US male adults

2020 ◽  
pp. jech-2020-214305
Author(s):  
Taeho Greg Rhee ◽  
Robert A Rosenheck
Keyword(s):  
Traumatic Events ◽  
Decomposition Analysis ◽  
White Men ◽  
Epidemiological Survey ◽  
Structural Factors ◽  
Black Adults ◽  
Black And White ◽  
Homeless Men ◽  
Younger Age ◽  
White Adults

BackgroundNon-Hispanic black adults experience homelessness at higher rates than non-Hispanic white adults in many studies. We aim to identify factors that could account for this disparity.MethodsWe used national survey data on non-Hispanic black and white men with complete data from the National Epidemiological Survey on Alcohol and Related Conditions Wave III. Using the Oaxaca-Blinder decomposition analysis, we examined race-based disparities in correlates of risk for lifetime homelessness.ResultsIn our analysis, 905 of 11 708 (7.7%) respondents, representing 6 million adults nationwide, reported lifetime homelessness. Black adults were 1.41 times more likely to have been homeless than white adults (95% CI 1.14 to 1.73; p=0.002). Overall, 81.6% of race-based inequality in lifetime homelessness were explained by three main variables with black adults having: lower incomes, greater incarceration histories since age of 18 and a greater risk of traumatic events (p<0.01 for each). They also had more antisocial personality disorder, younger age and parental drug use (p<0.05 for each).ConclusionAlthough previous studies suggested that black homeless men have higher rates of drug abuse than white homeless men, our findings highlight the fact that black–white disparities in lifetime homeless risk are associated with socio-structural factors (eg, income and incarceration) and individual adverse events (eg, traumatic events), and not associated with psychiatric or substance use disorders.

Abstract 2212: Vitamin D Intake: A Novel Neuroprotectant?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Suzanne E Judd ◽  
Anh Le ◽  
Dawn O Kleindorfer ◽  
Brett Kissela ◽  
Paul Muntner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cognitive Impairment ◽  
Racial Differences ◽  
Prior History ◽  
Black And White ◽  
Vitamin D Intake ◽  
Neurological Functioning ◽  
History Of ◽  
Record Review

Introduction Vitamin D is both a nutrient and hormone and has become increasingly studied as it relates to circulatory and neurological functioning. Vitamin D deficiency has been associated with Parkinson's disease, Alzheimer's disease, stroke, and dementia. It has also been related to hypertension and diabetes. We examined the role of vitamin D intake on incident stroke and incident cognitive impairment in a cohort of middle aged and older adults. Methods The Reasons for Geographic And Racial Differences in Stroke (REGARDS), a cohort of 30,239 participants, was recruited between 2003 and 2007 and is comprised of black and white Americans age 45 and older at baseline. Vitamin D intake was measured by the Block 98 food frequency questionnaire and categorized into tertiles. Participants are surveyed every six months for incident strokes which are adjudicated using medical record review. Cognitive functioning is assessed annually using the Six-item Screener (SIS)(score range 0-6). A score of 4 or below indicates impairment. For the incident stroke analysis, we excluded all people with prior history of stroke, and for the incident cognitive impairment analysis we excluded those with SIS scores<5 at baseline. Results: 26,039 participants were available for this analysis and were followed over a mean of 5 years. Higher intake of vitamin D was more likely for whites but did not differ by gender or age. Compared to the lowest tertile (range: 0-53.1 IU/day vitamin D), the highest tertile (range: 382-1774 IU/day) of vitamin D intake was associated with a 11% reduction in stroke (HR=0.89; 95% CI =0.79, 1.01) and 24% reduction in cognitive impairment (HR=0.76; 95% CI =0.67,0.86) after adjustment for age, race, income, education, hypertension, diabetes, dyslipidemia, history of heart disease, and BMI. When stratifying by race results were similar for both stroke and cognitive decline. Adding dairy intake to the models slightly attenuated the association but did not meaningfully change the interpretation of the results. Discussion: Results suggest a potential role of vitamin D in incident stroke and cognitive impairment. Clinical trials could evaluate the potential of Vitamin D as a neuroprotectant.

Sign in / Sign up

Export Citation Format

Share Document