NIH awards $40 million in grants to reduce stroke disparities in the US

Four research centers will develop high-impact culturally tailored interventions aimed at lowering stroke risk among racial and ethnic minorities in the United States. Together the centers are expected to receive $40 million in funding over five years, contingent on the availability of funds from the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

Compared to non-Hispanic whites, racial and ethnic minorities such as African-Americans, Hispanics/Latinos, Asian-Americans, and American Indians and Alaska Natives are more likely to experience a stroke and its related disability.

"Much of the disparity in stroke risk in the United States is due to the higher prevalence of cardiovascular risk factors such as elevated blood pressure among racial and ethnic minorities. A few of the grantees are working closely with at-risk populations to develop interventions that give people tools to achieve blood pressure control," said Walter J. Koroshetz, M.D., deputy director, NINDS. "These research efforts will give us the traction we need to control the greatest modifiable stroke risk factor. Together, the Stroke Prevention /Intervention Research Programs represent a much needed effort to address stroke disparities in the United States."

"Each program addresses disparity from a different perspective," said Salina P. Waddy, M.D., program director at NINDS. "One will address uncontrolled blood pressure and be delivered in an individual's home. Others will test community-based strategies to improve diet and exercise behaviors. Still others will bring into focus trends at the health care system and hospital levels."

These programs will serve to reduce disparities and make progress toward the stroke objectives and targets outlined in Healthy People 2020, the nation's disease prevention and health promotion goals, she said.

The four awardees and their program goals are:

Kaiser Permanente Northern California and the University of California, San Francisco will identify African-American enrollees in the Kaiser system who have uncontrolled blood pressure. Those who choose to participate in a controlled trial will be randomly assigned to one of three treatment groups: an intensive monitoring and drug dosage adjustment program, a culturally tailored diet and exercise intervention, or usual care. "The goal is to decrease the disparity in hypertension control between blacks and whites by 4 percent over one year; currently there is a 5 percent disparity in control between these racial groups," said Stephen Sidney, M.D., M.P.H., director of research clinics at the Kaiser Permanente Northern California's Division of Research in Oakland. Kaiser researchers also plan to investigate the causes of stroke in children and young adults. While this rate is still relatively low, stroke rates among young blacks in Kaiser Permanente more than doubled between 2000 and 2008, according to Dr. Sidney. The researchers will conduct studies to identify underlying reasons for this trend.

The NYU Langone Medical Center and Columbia University Medical Center have teamed up to create the Center for Stroke Disparities Solutions, a consortium that includes the State University of New York Downstate Medical Center, the Visiting Nurse Service of New York, five hospital-based stroke centers, and a research network of primary care practices within New York City's Health and Hospital Corporation – the largest municipal health care system in the United States. The first of the consortium's three projects in New York City will compare home blood pressure monitoring alone versus that intervention plus nurse case management by telephone, said Gbenga Ogedegbe, M.D., M.S., M.P.H., professor of population health and medicine at NYU Langone. The study will track reductions in blood pressure and prevention of recurrent stroke among 450 black and Hispanic stroke survivors with uncontrolled hypertension. "A second project will address the vulnerable period when stroke survivors transition from the hospital to their homes," said Olajide Williams, M.D., associate professor of clinical neurology at Columbia. The consortium will assess the effectiveness of a culturally tailored program to improve blood pressure control, level of functioning and quality of life in 650 homebound post-stroke patients. The team also will provide an educational video to African-American and Hispanic churches throughout New York City and gauge whether it boosts awareness about the need to call 911 immediately after the onset of even seemingly minor stroke symptoms.

The University of California, Los Angeles will focus on low-income Hispanic, African-American, and Asian-American populations in the Los Angeles basin area. The first study will measure if recurrent stroke risk is reduced when community health workers use mobile health technologies during home visits to empower recent stroke survivors to eat a healthy diet, exercise and to use blood pressure medications that can substantially lower the risk of another stroke, said Barbara Vickrey, M.D., M.P.H., professor of neurology at UCLA. A second study will test the impact of culturally tailored messages about stroke warning signs and a campaign to encourage walking among African-American, Hispanic, Chinese, and Korean senior center attendees. Data from the National Health and Nutrition Examination Survey will be analyzed to identify previously unknown risk factors for stroke among different racial and ethnic groups. The program's partners include Rancho Los Amigos National Rehabilitation Center, Healthy African American Families, and the City of Los Angeles Department of Aging.

A fourth program aims to better identify the causes of stroke disparity. The Florida Puerto Rico Collaboration to Reduce Stroke Disparities will leverage resources from University of Miami Miller School of Medicine, University of Puerto Rico, and Hospital HIMA-San Pablo Caguas, also in Puerto Rico. "Our mission is to improve the treatment and prevention of stroke among blacks and Hispanics in Florida and Puerto Rico," said Ralph L. Sacco, M.D., M.S., professor and chair of neurology at the University of Miami Miller School of Medicine. The investigators will develop a registry of acute stroke patients treated at nearly 140 hospitals throughout Florida and Puerto Rico. The hospitals are already using national guidelines and tracking their performance on key measures of stroke care quality such as the use of the clot-busting drug t-PA within three hours of stroke, and the initiation of other antithrombotic agents and smoking cessation counseling during hospitalization. The researchers hope to gain a better understanding of the underlying factors that contribute to higher stroke risk among racial and ethnic minorities, and to identify opportunities for improvement.

May is National Stroke Awareness month. For more information, go to http://www.facebook.com/KnowStroke

NINDS is the nation's leading funder of research on the brain and nervous system. The NINDS mission is to reduce the burden of neurological disease – a burden borne by every age group, by every segment of society, by people all over the world.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.