Thursday, February 02, 2023

MISOGYNISTIC MEDICINE

Dual blood thinners under prescribed after minor or warning stroke, especially in women


American Stroke Association International Stroke Conference 2023, Abstract 43

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • In a recent study, less than half of the people were prescribed dual blood-thinning therapy, despite evidence that starting two anti-platelet blood thinning medications, such as aspirin or clopidogrel, may reduce the short-term risk of recurrent stroke after a minor stroke or a transient ischemic attack (TIA) - also known as a warning stroke.
  • In the analysis of medications prescribed to nearly 3,000 stroke survivors at discharge from stroke centers in Maryland, only 40% of patients were prescribed dual anti-platelet therapy, and women were significantly less likely to be prescribed two anti-platelet medications compared to men. This gender gap in treatment echoes under-treatment of women in other aspects of cardiovascular disease care.
  • Increasing the use of dual anti-platelet therapy, particularly in women, may lead to a lower rate of stroke recurrence after a minor stroke or TIA.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 2, 2023

DALLAS, Feb. 2, 2023 — Despite evidence that starting two blood-thinning medications shortly after a minor stroke or a warning stroke (transient ischemic attack - TIA) may prevent a second – possibly more serious – clot-caused stroke within a few months, the treatment regimen is underused especially among women, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Blood thinners, such as aspirin and clopidogrel, prevent platelets from sticking together and forming blood clots. Prescribing two anti-platelet medications at the same time is known as dual antiplatelet therapy (DAPT). In recent trials, DAPT has been shown to reduce the short-term risk of another stroke in people with a recent minor stroke (mild, non-disabling symptoms) or with a TIA. As with most strokes, a TIA is caused by a clot temporarily blocking blood flow to the brain, however, TIA symptoms usually only last a few minutes and result in no permanent brain injury or physical disability.

“All stroke survivors, regardless of sex, should receive optimal proven medications for stroke prevention including DAPT when medically appropriate,” said Jonathan Solomonow, M.D., lead author of the study and chief resident in neurology at the University of Maryland Medical Center in Baltimore.

To gauge how often DAPT was being prescribed when people with a minor stroke or TIA were discharged, the researchers reviewed the electronic health records of 2,953 adults admitted to one of the hospitals of the University of Maryland Stroke Clinical Network. The Maryland network includes nine stroke centers located in urban, suburban and rural hospitals serving a diverse population. All were treated for minor stroke or TIA between 2018 and 2021. None were taking blood thinning medication such as warfarin or apixaban before the stroke or TIA. The participants were average age 67 years; 42% were age 70 or older; 48% women, 37% Black adults and 60% white adults.

The analysis found:

  • DAPT was underutilized across all hospitals reviewed, prescribed to just 40% of the overall patients.
  • Men were more likely than women (43% vs. 37%, respectively) to be prescribed DAPT.
  • The percentage of patients receiving DAPT did not differ significantly by race, age or whether the person was treated at a stroke center that delivers specialized stroke care.

“There are an increasing number of options available to prevent and reduce the risk of a recurrent stroke, including high blood pressure medications, statins to control cholesterol and dual blood thinners. Patients and their family members should inquire about the use of DAPT after a stroke or TIA to consider if DAPT may be beneficial,” Solomonow said.

The gender gap noted in the study could not be explained by differences in insurance coverage or in anticipated side effects of the medications, Solomonow added.

“The gender gap was not entirely surprising because there is extensive literature indicating that women with cardiovascular disease tend to be undertreated. For example, some studies show that women with heart disease or stroke are not prescribed  statins as frequently as men. In addition, women with atrial fibrillation receive ablation less often than men,” Solomonow said. “Further research is needed to examine whether women are less likely to receive other proven therapies, such as statins for stroke prevention and anti-coagulation for atrial fibrillation.”

The study analyzed data from a single health system in Maryland, so the findings need to be confirmed in other settings including hospitals that are not certified stroke centers.

“Identifying systemic inequities is essential to improving patient care across all demographics. It would be useful for other centers to explore whether sex differences are present in other parts of the U.S. or health care systems in other countries,” Solomonow said.

Co-authors are Jamie R. Marks, Ph.D.; Karen L. Yarbrough, C.R.N.P.; Prachi Mehndiratta, M.B.B.S.; and Seemant Chaturvedi, M.D. Authors’ disclosures are listed in the abstract.

The study was funded by the department of neurology at the University of Maryland.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:


Recurrent stroke risk decreasing, with twice the decline among women vs. men in South Texas


American Stroke Association International Stroke Conference 2023, Abstract 82

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • The risk of recurrent stroke has declined in the past 20 years among all stroke survivors, with twice the decline among women vs. men, according to a study conducted in South Texas.

  • Researchers suggest more study is needed to understand the reasons behind the welcome decline in trends in stroke recurrence for both sexes, as well as the reasons for the changes in sex differences over time.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 2, 2023

DALLAS, Feb. 2, 2023 — The risk of recurrent stroke has declined in the past 20 years among all stroke survivors, with twice the decline among women compared to men, according to preliminary research conducted in South Texas that will be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Stroke Association, a division of the American Heart Association, after a first stroke, about 1 in 4 people will go on to have another. The majority of recurrent strokes are preventable through the same lifestyle changes, and medication if necessary, that may help prevent a first stroke or other cardiovascular diseases.

In the Brain Attack Surveillance in Corpus Christi (BASIC) Project in South Texas, researchers analyzed the frequency of recurrent stroke between January 1, 2000, and December 31, 2019 among nearly 6,000 first-time ischemic stroke survivors. Half of the stroke survivors were women, and their average age was 69 years. Participants self-identified as Mexican American (52.5%), non-Hispanic white (40.4%) and other races or ethnicities (7.1%).

The analysis found:

  • Overall, nearly 14 out of 100 stroke survivors had a second stroke within about 8 years.
  • In 2000, approximately 11 out of 100 women had a recurrent stroke within one year, compared to 8 out of 100 men.
  • Over the two decades, the risk of recurrent stroke declined among all stroke survivors; however, women experienced twice the decline compared to men. Fewer than 4 out of 100 women experienced a recurrent stroke one year after a first stroke, compared to nearly 5 out of 100 men.
  • Similar results occurred five years after a first stroke, with 8 out of 100 women compared to 10 out of 100 men experiencing a recurrent stroke.

“Secondary stroke prevention has been successful; however, it has not been as effective among male stroke survivors in recent years,” said study lead author Chen Chen, M.S., a Ph.D. candidate in epidemiology at the University of Michigan in Ann Arbor. “We were somewhat surprised that our results showed that in recent years men had similar or even higher chances of having a second stroke compared with women.”

The study had a few limitations. One limitation is that all study participants lived in one South Texas community (Nueces County, Texas), so the results may not apply to people living in other areas. Another limitation is that the study did not include details about subtypes of recurrent stroke, which may point to additional risk factors and the need for more targeted secondary prevention strategies.

“Further research is needed to understand the reasons behind the welcome declining trends in stroke recurrence for both sexes, particularly the reasons for differences over time by sex,” Chen said. “This information will help policymakers understand where to focus efforts that may further improve secondary stroke prevention and reduce or prevent health inequities.”

According to the American Stroke Association, a division of the American Heart Association, worldwide, stroke is the second-leading cause of death after heart disease. Stroke is a medical emergency that occurs when the blood vessels to the brain become blocked, which is an ischemic stroke, the most common type, or they may burst, which is a hemorrhagic stroke. Immediate treatment to restore blood flow and oxygen to the brain may help prevent permanent disability. The abbreviation F.A.S.T. — for face drooping, arm weakness, speech difficulty, time to call 911 — is a useful tool to recognize the warning signs of stroke and when to call for help.

Co-authors are Kevin He, Ph.D.; Mathew J. Reeves, Ph.D.; Lewis B. Morgenstern, M.D.; Karen B. Farris, Ph.D.; and Lynda D. Lisabeth, Ph.D. Authors’ disclosures are listed in the abstract.

The study was funded by the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.


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Poor oral health may contribute to declines in brain health

American Stroke Association International Stroke Conference 2023, Abstract 126

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:


  • Adults who are genetically prone to poor oral health may be more likely to show signs of declining brain health than those with healthy teeth and gums.

  • Early treatment of poor oral health may lead to significant brain health benefits.

DALLAS, Feb. 2, 2023 — Taking care of your teeth and gums may offer benefits beyond oral health such as improving brain health, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually, Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Studies have shown that gum disease, missing teeth and other signs of poor oral health, as well as poor brushing habits and lack of plaque removal, increase stroke risk. According to the American Stroke Association, stroke is the number 5 cause of death and a leading cause of disability in the United States. Previous research has also found that gum disease and other oral health concerns are linked to heart disease risk factors and other conditions like high blood pressure.

“What hasn’t been clear is whether poor oral health affected brain health, meaning the functional status of a person’s brain, which we are now able to understand better using neuroimaging tools such as magnetic resonance imaging or MRI,” said study author Cyprien Rivier, M.D., M.S., a postdoctoral fellow in neurology at the Yale School of Medicine in New Haven, Connecticut. “Studying oral health is especially important because poor oral health happens frequently and is an easily modifiable risk factor – everyone can effectively improve their oral health with minimal time and financial investment.”

Just as healthy lifestyle choices impact the risk of heart disease and stroke, they also affect brain health, which includes one’s ability to remember things, think clearly and function in life. Three in five people in the U.S. will develop brain disease in their lifetime, according to latest estimates from the American Stroke Association, a division of the American Heart Association.

Between 2014 and 2021, researchers in this study analyzed the potential link between oral health and brain health among about 40,000 adults (46% men, average age 57 years) without a history of stroke enrolled in the U.K. Biobank. Participants were screened for 105 genetic variants known to predispose persons to have cavities, dentures and missing teeth later in life, and the relationship between the burden of these genetic risk factors for poor oral health and brain health was evaluated.

Signs of poor brain health were screened via MRI images of the participants’ brains: white matter hyperintensities, defined as accumulated damage in the brain’s white matter, which may impair memory, balance and mobility; and microstructural damage, which is the degree to which the fine architecture of the brain has changed in comparison to images for a normal brain scan of a healthy adult of similar age.

The analysis found:

  • People who were genetically prone to cavities, missing teeth or needing dentures had a higher burden of silent cerebrovascular disease, as represented by a 24% increase in the amount of white matter hyperintensities visible on the MRI images.
  • Those with overall genetically poor oral health had increased damage to the fine architecture of the brain, as represented by a 43% change in microstructural damage scores visible on the MRI scans. Microstructural damage scores are whole-brain summaries of the damage sustained by the fine architecture of each brain region.

“Poor oral health may cause declines in brain health, so we need to be extra careful with our oral hygiene because it has implications far beyond the mouth,” Rivier said. “However, this study is preliminary, and more evidence needs to be gathered – ideally through clinical trials – to confirm improving oral health in the population will lead to brain health benefits.”

The analysis was limited by the fact that the UK Biobank includes only people who reside in the U.K., and they are predominantly of European ancestry (94% of the U.K. Biobank participants reported their race as white vs. 6% reported as mixed, Black British, Asian British or other). In addition, more research among people from diverse racial and ethnic backgrounds is needed.

American Stroke Association, a division of the American Heart Association, Stroke Council member and volunteer expert Joseph P. Broderick, M.D., FAHA, a professor at the University of Cincinnati Department of Neurology and Rehabilitation Medicine and director of the University of Cincinnati Gardner Neuroscience Institute in Cincinnati, Ohio, said while the study results don’t demonstrate that dental hygiene improves brain health, the findings are “intriguing” and should prompt more research.

“Environmental factors such as smoking and health conditions such as diabetes are much stronger risk factors for poor oral health than any genetic marker – except for rare genetic conditions associated with poor oral health, such as defective or missing enamel,” Broderick said. “It is still good advice to pay attention to oral hygiene and health. However, since people with poor brain health are likely to be less attentive to good oral health compared to those with normal brain health, it is impossible to prove cause and effect. Also, genetic profiles for increased risk of oral health may overlap with genetic risk factors for other chronic health conditions like diabetes, hypertension, stroke, infections, etc. that are known to be related to brain imaging markers.“ Broderick was not involved in this study.

Co-authors are Daniela Renedo, M.D.; Adam H. de Havenon, M.D., M.S.C.I.; Sam Pyabvash, M.D.; Kevin N. Sheth, M.D.; and Guido J. Falcone, M.D., Sc.D., M.P.H. Authors’ disclosures are listed in the abstract.

The study was funded by the American Heart Association through the Bugher Center for Hemorrhagic Stroke Research Network (AHA grant #817874). U.K. Biobank data were accessed using project application 58743.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.

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RACIST MEDICINE U$A

Lifestyle biomarker linked to high blood pressure, increased stroke risk among Black adults


American Stroke Association International Stroke Conference 2023, Abstract 83

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • Researchers have identified a lifestyle-related biomarker called gluconic acid that may be a target to reduce stroke risk in Black adults.
  • Higher levels of gluconic acid in the blood were associated with high blood pressure and increased risk of ischemic stroke among Black adults when compared to white adults.
  • Among Black adults, a higher level of gluconic acid was associated with a Southern diet (foods high in added fats, fried foods, processed meats and sugary drinks), a lower level of education and a lack of exercise.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 2, 2023

DALLAS, Feb. 2, 2023 — Researchers have identified a lifestyle-related metabolite biomarker called gluconic acid that is associated with high blood pressure, increased risk of ischemic stroke, eating a Southern diet, lower level of education and lack of exercise, among Black adults, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Stroke Association, a division of the American Heart Association, stroke is one of the leading causes of death and disability in the U.S., and African Americans have long experienced a higher rate of stroke. Currently, researchers are investigating new risk factors such as variations in blood levels of metabolites that might explain these differences. Metabolites are substances in the blood produced while exercising or in the breakdown of food and medications during metabolism.

“We have identified a biomarker called gluconic acid that we believe is a lifestyle-related biomarker, providing a direct link to diet and exercise,” said Naruchorn Kijpaisalratana, M.D., Ph.D., lead study author and a research fellow in neurology at Massachusetts General Hospital in Boston. “Gluconic acid may be considered as a dietary-related oxidative stress marker due to its availability in food, potentially produced by the gut microbiome, and related to diseases with oxidative stress. We think that this biomarker may provide a pathway to improve diet and exercise habits to help prevent a future stroke.“

The study analyzed health data for more than 2,000 people participating in the Reasons for Geographic and Racial Difference in Stroke (REGARDS) study. The ongoing REGARDS study has enrolled more than 30,000 Black and white adults since 2003 from the Southeastern U.S., known as the “stroke belt,” and other states across the country. The aim of REGARDS is to investigate the reasons for the high rate of stroke among African Americans.

This new analysis included 1,075 ischemic stroke survivors during a mean follow-up period of 7 years. Of those, 439 were Black adults and 636 were white adults (mean age of 70 years; 50% female). A random comparison group drawn from study participants consisted of nearly 1,000 Black adults and white adults who had not had a stroke (mean age of 65 years; 55% female).

The samples used in this study were collected from REGARDS participants over a 4-year period of enrollment (from 2003 to 2007). Using the samples, researchers extracted and measured levels of 162 metabolites in the blood of the participants. The data analysis examining the association between these metabolite levels and high blood pressure and future risk of ischemic stroke in both the Black and white adults was performed in 2021-2022.

The study found:

  • Of the 162 metabolites that were measured, elevated levels of the metabolite gluconic acid were found in Black adults who had high blood pressure but not their white peers with high blood pressure.
  • Black adults with the highest gluconic acid levels were 86% more likely to have high blood pressure.
  • Black adults with the highest gluconic acid levels had a 53% increased risk of ischemic stroke. No such association was found for white participants.
  • Gluconic acid accounted for 25% of the association between high blood pressure and stroke among Black adults.
  • In Black adults, after adjusting for multiple factors, a higher level of gluconic acid was associated with a Southern diet (foods high in added fats, fried foods, processed meats and sugary drinks), a lower level of education and a lack of exercise.

The researchers suggest that a blood test measuring metabolites may be able to determine if diet and exercise are working to lower stroke risk. “In the future, we envision that a metabolite like gluconic acid may be used as a biomarker to inform health care professionals whether the patient is eating healthy enough or exercising enough,” Kijpaisalratana said. “A biomarker like gluconic acid may point individuals toward more targeted guidance for stroke prevention.”

A limitation of the study was that the participants had high blood pressure at the beginning of the study, so researchers were not able to track the condition as it developed.

“Given the longstanding, higher risk of stroke among Black versus white adults in the United States — which is still not fully explained by a higher frequency of traditional stroke risk factors — the discovery of a new, potential prognostic marker or therapeutic target is very important,” said Bruce Ovbiagele, M.D., M.Sc., M.A.S., M.B.A., M.L.S., FAHA, American Heart Association expert volunteer and associate dean and professor of neurology at the University of California, San Francisco and chief of staff at the San Francisco Veteran Affairs Health Care System. “Since previous studies have found that culturally tailored lifestyle educational approaches may help to improve blood pressure control in Black adults, gluconic acid might serve as an objective measure to inform health care professionals about how well their patients are doing reducing hypertension and stroke risk and may also be helpful to motivate Black patients to modify their lifestyles as appropriate to prevent stroke.”

Ovbiagele, who was not involved in this study, also noted that future studies will need to examine the relationship between gluconic acid and the known social determinants of cerebrovascular health, including psychosocial stress and stroke risk, among Black adults compared to their white counterparts. Additional research will also need to explore whether this relationship holds true for recurrent stroke risk, too, since about one out of four strokes is a recurrent stroke.

Co-authors are Zsuzsanna Ament, Ph.D.; Amit Patki M.D.; Varun Mahesh Bhave, M.D.-candidate; Ana-Lucia Garcia Guarniz, M.D.; Suzanne E. Judd, Ph.D.; Mary Cushman, M.D., M.Sc.; Leann Long, Ph.D.; Marguerite M. Irvin, Ph.D.; and W. Taylor Kimberly, M.D., Ph.D. Authors’ disclosures are listed in the abstract.

The study was funded by the National Institutes of Health and the American Heart Association.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.


Black and Hispanic people in U.S. less likely to get treatment for stroke complications

American Stroke Association International Stroke Conference 2023, Abstract 146

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • Analysis of 20 years of data found Black and Hispanic adults in the U.S. were less likely to be treated for certain complications, such as depression and muscle stiffness, after a stroke compared to their white peers.
  • The greatest difference in the treatment of complications among Black and Hispanic stroke survivors occurred mainly within two weeks after a stroke.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 2, 2023

DALLAS, Feb. 2, 2023 — Analysis of 20 years of electronic health records across the U.S. finds Black and Hispanic stroke survivors were less likely than white stroke survivors to receive treatment for common complications during the first year after their stroke, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Despite increases in recent decades in the overall stroke survival rates in the U.S., Black and Hispanic adults in the U.S. still consistently fare worse in their recovery from a stroke when compared to their peers who are white. According to a new study, differences in the treatment of complications immediately after a stroke may possibly explain these persistent health disparities.

“A constellation of symptoms may manifest after a stroke; however, not all complications are life-threatening events. Some complications may be more subtle and go undetected by the medical community and, as a result, people from different racial or ethnic groups may not receive equitable treatment,” said lead study author “Stroke may have a devastating impact on an individual’s quality of life, and I think we owe it to our patients to do what we can to improve their level of function and quality of life after a stroke.”

In this study, Using electronic medical records from 65 large health care centers across the U.S., the analysis included patients hospitalized with stroke between August 2002 and July 2022. The records were divided into three patient groups (Black, non-Hispanic white and Hispanic): 80,564 Black stroke survivors were matched to 80,564 non-Hispanic white stroke survivors; and 28,375 non-Hispanic white stroke survivors were matched to 28,375 Hispanic stroke survivors. All participants were older than 18 years with an average age of 64 and 54% were male.

Stroke survivors were matched based on 41 factors that may affect recovery, including age, sex and other health conditions, such as hypertension and diabetes (Type 1 and 2). After matching there were no significant group differences for any of 41 factors. For the analysis, researchers reviewed medications prescribed for six common stroke complications: central nervous system arousal/fatigue (foggy brain function); mood irregularities (depression/anxiety); spasticity (muscle stiffness); sleep problems; bladder incontinence; and seizure. They then compared the differences in the treatment of these conditions after a stroke among the people who had these complications at three points in time: 14 days, 90 days and 365 days after the stroke.

The analysis revealed:

  • Black stroke survivors were significantly less likely to be treated for any complications except seizure, compared to stroke survivors who were white. The largest difference was seen in the treatment of arousal/fatigue, spasticity, and mood at the 14-day mark. Compared to stroke survivors who were white adults, those who were Black adults were 30% less likely to be treated for central nervous system arousal, 27% less likely to be treated for spasticity and 17% less likely to be treated for mood irregularities.
  • In the comparison of Hispanic vs. non-Hispanic white stroke survivors at the 14-day mark, Hispanics survivors were 20% less likely to receive treatment for central nervous system arousal; 19% less likely to receive treatment for spasticity; and 16% less likely to receive treatment for mood irregularities.
  • Little to no differences in the treatment of seizure were seen between the three patient groups at all three time periods.

“When a patient is having a seizure, the physical manifestations are often clear and demand urgent treatment. However, for other symptoms like foggy brain function or depression, health care professionals must dig a little deeper to assess for these signs or symptoms and determine if treatment is warranted. This difference between seizures and the other more subtle symptoms is the important take away,” Simmonds said. ”We found that the disparities among different population groups narrowed a little over time, and this likely shows that some of these conditions are being recognized and treated. However, even at the one-year mark, the overall treatment disparities remain for the treatment of nearly all post-stroke complications.”

The main limitation of this analysis is that a large database review like this can identify racial disparities in stroke care, however, it is less attuned to identify the specific factors driving them. “These differences are real and persistent, so it’s a matter of finding them, one by one, and filling these gaps,” Simmonds said.

The research team plans to test various intervention strategies that may help stroke survivors who are Black or Hispanic achieve a better functional recovery after their stroke.

“Communication moving forward is important. Many people survive their stroke, so health care professionals need to ask patients about these other subtle symptoms that may indicate additional complications, in addition to traditional risk factors such as blood glucose levels or blood pressure. These other domains have an important impact on our patients’ post-stroke, day-to-day quality of life.”

“It is very important for stroke survivors to receive treatment for subsequent complications. Successful recovery and quality of life depend upon the identification and management of post stroke complications,” said American Stroke Association, a division of the American Heart Association, volunteer expert Karen L. Furie, M.D., M.P.H., FAHA, vice chair of the Association Stroke Brain Health Science Subcommittee and professor and chair of neurology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island. “Understanding the factors that contribute to these differences in treatment will empower clinicians to deliver high-quality, equitable care to stroke patients.” Dr. Furie was not involved in this study.

Co-authors are Folefac D. Atem, Ph.D.; Babu G. Welch, M.D.; and Nneka L. Ifejika, M.D., M.P.H. Authors’ disclosures are listed in the abstract.

No funding was reported for this study.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:


Study finds Mexican American stroke survivors were less likely to receive intensive rehab


American Stroke Association International Stroke Conference 2023, Abstract WMP28

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • While previous research has indicated Mexican Americans have worse stroke outcomes, this study found they were more likely to have less intensive rehabilitation, such as home health and outpatient services, during the three months after their stroke compared to their non-Hispanic white peers.
  • Nearly one-third of all stroke survivors in the South Texas study, which included Mexican American adults, did not receive any type of rehabilitation within 90 days of their stroke.

DALLAS, Feb. 2, 2023 — Mexican American stroke survivors in a South Texas study, were more likely to use less intensive forms of rehabilitation services than their non-Hispanic white peers, and nearly one-third of all the stroke survivors did not receive any rehabilitation within 90 days of their stroke, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Even though stroke death rates among Mexican Americans are lower than their non-Hispanic white peers, previous research has shown that they often have worse outcomes and suffer greater disability after their stroke. One factor contributing to how well stroke survivors recover is the type of rehabilitation they receive in the window of time after the stroke, explained lead study author Lynda Lisabeth, Ph.D., M.P.H., a professor of epidemiology at the University of Michigan in Ann Arbor.

“The more intensive forms of stroke rehabilitation that are provided at inpatient or skilled nursing facilities have better outcomes than less intensive forms of rehabilitation,” Lisabeth said. “Our objective was to identify what factors may impact the type of rehabilitation a person gets. We want to know if there are barriers to getting the most intensive level of rehabilitation, then we can develop interventions that target those barriers, which will help to maximize rehabilitation across the board and potentially reduce these disparities.”

Researchers examined the link between ethnicity and the use and type of rehabilitation accessed by stroke survivors during the first 90 days after a stroke. They enrolled 554 participants from a South Texas community in the Brain Attack Surveillance in Corpus Christi Project (BASIC) soon after their stroke. Two-thirds of the participants were Mexican American adults (66%), and one third were non-Hispanic white adults. Nearly half were women, and the median age was 66 years.

The study was conducted between 2019 and 2021. During this period researchers conducted telephone interviews to determine the type of rehabilitation the stroke survivors received after hospital discharge, such as: outpatient, home health, inpatient or a skilled nursing facility. Participants were called every two weeks for three months and asked about their care. Based on in-person and telephone interviews, assessments were made of functional ability and depression at 90 days, along with information about the type of post-discharge care received.

The study found:

  • One-third of all study participants did not receive any type of rehabilitation during the three months after their stroke.
  • Two thirds (67%) of Mexican American stroke survivors, compared to just over half (56%) of non-Hispanic white peers, received some form of post stroke rehabilitation.
  • Mexican American stroke survivors were younger (median age of 65 vs. 70 for non-Hispanic whites), had lower levels of education and income, more health problems, higher average body mass index, and worse functional outcome and depression at 90 days compared to non-Hispanic white peers in this study.
  • After accounting for multiple factors such as age, income and other health conditions, Mexican American stroke survivors had almost two times higher odds of using any rehabilitation than non-Hispanic white stroke survivors.
  • Mexican American stroke survivors were more likely to use outpatient (11% vs. 5%, respectively) and home health rehabilitation (38% vs. 30%, respectively) when compared to their non-Hispanic white peers.
  • There were no major differences in the use of inpatient rehabilitation and skilled nursing facilities between the Hispanic and non-Hispanic white groups.

“There are many factors that drive the type of rehabilitation stroke survivors receive or if they can access rehabilitation. We want to better understand the barriers and preferences of Mexican American stroke survivors, so we may help develop culturally sensitive interventions that may increase the chances of stroke survivors going to inpatient rehabilitation, which contributes to better recovery,” Lisabeth said.

The study is limited by its small size and its focus on one community in South Texas (Nueces County, Texas), which suggests these results may not apply to other communities across the country. “This community has a higher proportion of Mexican American people in an urban setting with a unique availability of rehabilitation. The study also took place over a period of time that overlapped with the COVID-19 pandemic,” Lisabeth said.

The researchers note future studies focused on barriers and facilitators to intensive rehabilitation, especially among Mexican American stroke survivors, may be a way to reduce disparities and make substantial improvements in recovery.

The American Heart Association/American Stroke Association’s 2021 Clinical Performance Measures for Stroke Rehabilitation: Performance Measures were developed to focus on key aspects of stroke rehabilitation that are important to maintaining quality of care for stroke patients. They cover various aspects of stroke rehabilitation in the acute, post-acute inpatient, outpatient and home settings.

According to those measures, stroke is among the most common causes of acquired disability among adults in the United States, with more than 7 million Americans over 20 years of age having experienced a stroke in the past and almost 2.5% of Americans reporting that they are disabled as a result of stroke. People in the U.S. discharged from the hospital after stroke received their rehabilitation care at either an inpatient rehabilitation facility (19%), skilled nursing facility (25%) or through home care services (12%).

“Rehabilitation after a stroke is a key factor in recovery and the return to independent functioning,” said Joel Stein, M.D., FAHA, chair of the writing group for the American Heart Association/American Stroke Association clinical performance measures and the Simon Baruch Professor and chair of the department of rehabilitation and regenerative medicine at Columbia University’s Vagelos College of Physicians and Surgeons; professor and chair of the department of rehabilitation medicine at Weill Cornell Medicine; and physiatrist-in-chief at NewYork-Presbyterian Hospital. “Exploring differences in care and disparities is an essential method of understanding gaps in care and improving systems of care for stroke survivors. Many factors may influence the delivery of rehabilitation care post-stroke. Stroke survivors with substantial impairments who have fewer financial resources and less social support may struggle with direct discharge from the hospital to home.” Dr. Stein was not involved in this study.

Co-authors are Madeline Kwicklis, M.S.; Elizabeth Almendarez, Ph.D.; Janet Prvu-Bettger, Sc.D., FAHA; and Lewis B. Morgenstern, M.D., FAHA. Authors’ disclosures are listed in the abstract.

The study was funded by the National Institutes of Health.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

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New research turns what we know about bird window strikes inside-out

Researchers at William & Mary demonstrate that bird decals must be placed on the outside of windows to deter bird collision

Peer-Reviewed Publication

PEERJ

January 17, 2923 (Williamsburg, VA) - New research from William & Mary published in PeerJ Life & Environment reveals that decals intended to reduce incidents of bird window strikes—one of the largest human-made causes of bird mortality— are only effective if decals are placed on the outside of the window. Researchers found that the patterns on the films and decals placed on the internal surface of windows do not reduce collision because they may not be sufficiently visible to birds.


Bird window strikes occur when a bird flying near a building cannot perceive a glass windowpane and flies into it. These strikes are a significant concern for bird enthusiasts and conservationists, many of whom advocate for applying visibly noticeable films, patterns, and decals on surfaces of windows to alert birds of the glass.

Many people sympathetic to the potential of bird strikes around their homes or offices tend to apply decals to the inside of their windowpanes, primarily because external application is often logistically difficult and economically prohibitive, especially if the windows are above the first floor of a building. However, the results of this new study show that only external application of these decals can be associated with greater reductions in both window collisions and avian mortality.


Dr. John P. Swaddle, of William & Mary’s Institute for Integrative Conservation worked with students Blythe Brewster, Maddie Schuyler, and Anjie Su, to perform the first experimental study to compare the effectiveness of two distinct window films when applied to either the internal or external surface of double-glazed windows. The research team tested two different window film products: BirdShades and Haverkamp. These products were selected for the test because they engage with different wavelenths of light and colors visible to many songbirds.

Funding for the test of the BirdShades window film was provided by BirdShades Innovation GmbH. Using these films, the research team tested the avoidance of window collisions by zebra finches through controlled aviary flight trials. The team employed a design that allowed isolation of the effect of the window treatments on avoidance flight behaviors. A fine mist net in front of the windows prevented actual bird collision during the tests.

The team found consistent evidence that when applied to the external surface of windows, the films resulted in reduced likelihood of collision. However, neither product was effective when the films were applied to the internal surface of windows. Therefore, the results of this research demonstrate the imperative that installers apply these products to exterior surfaces of windows to maximize their protective benefits and reduce the risk of daytime window collision.

“Many people want to reduce bird-window collisions, as these unfortunate events kill hundreds of millions of birds each year,” says Dr. Swaddle. “There are lots of decals and window films that will likely make glass surfaces more visible to birds, decreasing collision risk. We were able to show that people must apply decals and films to the external surface of their windows to benefit the birds. We want people to know this as we want their time and money to be well spent—protecting the birds we all love.” Swaddle added “This research was conducted with a team of William & Mary undergraduate researchers, demonstrating the caliber of William & Mary students and the promise of the next generation of conservation
researchers."

PeerJ is an Open Access publisher of seven peer-reviewed journals. PeerJ’s mission is to give researchers the publishing tools and services they want with a unique and exciting experience. All works published by PeerJ are Open Access and published using a Creative Commons license (CC-BY 4.0). PeerJ is based in San Diego, CA and the UK and can be accessed at peerj.com.

In 2022 PeerJ is celebrated its first decade of publishing and innovation.

PeerJ is the peer-reviewed journal for Biology, Medicine and Environmental Sciences. PeerJ has an Editorial Board of over 2,000 respected academics. PeerJ Media Resources (including logos) can be found at: peerj.com/about/press

Notes to editor:
1. Research article:
Authors: John P. Swaddle, Blythe Brewster, Maddie Schuyler, Anjie Su
"Window films increase avoidance of collisions by birds but only when applied to external compared with
internal surfaces of windows”. PeerJ.
DOI: 10.7717/peerj.14676
This article is available at the Journal website https://peerj.com/articles/14676/ (after embargo 02 Feb)
2. Study Image: Swaddle, John.2022.birdstriketest.moviestill.jpeg

JOURNAL

PeerJ

DOI

10.7717/peerj.14676 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Window films increase avoidance of collisions by birds but only when applied to external compared with internal surfaces of windows

ARTICLE PUBLICATION DATE

2-Feb-2023

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SIXTY YEARS LATE(R)

UC Davis establishes Institute for Psychedelics and Neurotherapeutics

Business Announcement

UNIVERSITY OF CALIFORNIA - DAVIS

The University of California, Davis has launched the Institute for Psychedelics and Neurotherapeutics to advance basic knowledge about the mechanisms of psychedelics and translate it into safe and effective treatments for diseases such as depression, post-traumatic stress disorder, addiction, Alzheimer’s disease and Parkinson’s disease, among others. The new institute will bring together scientists across a range of disciplines and partner with the pharmaceutical industry to ensure that key discoveries lead to new medicines for patients. 

“Psychedelics have a unique ability to produce long-lasting changes in the brain that are relevant to treating numerous conditions,” said David E. Olson, associate professor in the Department of Chemistry and the Department of Biochemistry and Molecular Medicine at UC Davis. “If we can harness those beneficial properties while engineering molecules that are safer and more scalable, we can help a lot of people.”

Olson will be the founding director of the new institute, with John A. Gray, associate professor in the Department of Neurology, serving as associate director. In 2018, Olson and Gray published an influential study in Cell Reports demonstrating that psychedelics promote neuroplasticity — the growth of new neurons and formation of neural connections.  

“Neuronal atrophy is a key factor underlying many diseases,” said Gray, “and the ability of psychedelics to promote the growth of neurons and new connections in the brain could have broad therapeutic implications.”

A Historic Investment

The UC Davis institute will be funded in part by a contribution of approximately $5 million from the deans of the College of Letters and Science and the School of Medicine, the Vice Chancellor for Research and the Provost’s office. While other psychedelic science centers have been formed across the country with gifts from philanthropists, the UC Davis institute is notable for also being supported by substantial university funds.

“We wanted to put our money where our mouth is and demonstrate our commitment to this space,” said Estella Atekwana, dean of the College of Letters and Science overseeing the new institute. Additionally, philanthropic donations as well as grants and sponsored research agreements from the federal government, private foundations and industry partners will support the mission of the institute.  

“UC Davis has been leading the development of new medicines based on psychedelic research, and together with philanthropists, granting agencies and industrial partners, I’m confident that we can produce major benefits for society,” Atekwana said.

Leveraging strengths in chemistry, neuroscience and medicine

The institute will leverage the extraordinary breadth of expertise in the neuroscience community at UC Davis, which includes nearly 300 faculty members in centers, institutes and departments across the Davis and Sacramento campuses. Researchers will be able to work on every aspect of psychedelic science, from molecules and cells through to human clinical trials.

“Combining the considerable expertise of UC Davis’ pioneering basic research teams, world-class neuroscientists and our nationally recognized medical center is a formula for success that we trust will result in groundbreaking discoveries that will help patients regionally and worldwide,” said Susan Murin, dean of the School of Medicine who partnered with Atekwana to support the new institute.

The Institute for Psychedelics and Neurotherapeutics was specifically designed to facilitate collaborations across campus, such as that between Olson and Lin Tian, a professor in the Department of Biochemistry and Molecular Medicine. In 2021, their publication in Cell was voted the #2 biomedical research discovery of the year by STAT Madness.

A unique feature of the UC Davis institute will be its focus on chemistry and the development of novel neurotherapeutics. 

“Psychedelics have a lot of therapeutic potential, but we can do better,” said Olson. In 2020, his group published a paper in Nature describing the first non-hallucinogenic analogue of a psychedelic compound capable of promoting neuroplasticity and producing antidepressant and anti-addictive effects in preclinical models.  Olson calls these molecules psychoplastogens because of their effect on neuron growth.  Novel molecules tailored to specific disease indications could offer substantial benefits and open doors to partnerships with industry by solving many issues currently faced by traditional psychedelics related to safety, scalability, and intellectual property.

Bridging the Valley of Death between Academia and Industry

Major challenges exist for translating academic discoveries and promising lead compounds into drug candidates for clinical use. To bridge this gap, the institute aims to spin out companies and build strong collaborations with pharmaceutical partners through licensing and sponsored research agreements. Delix Therapeutics, a company co-founded by Olson, has licensed UC Davis technology and supported several cutting-edge basic research projects on campus related to psychoplastogens and neuroplasticity. Recently, Delix was named a top academic spinout company by Nature Biotechnology and C&E News, and in 2021, was named one of the Fierce 15 by Fierce biotech.  

“Our relationship with UC Davis has been very synergistic, and we are excited to continue that partnership,” said Mark Rus, the CEO of Delix. “Getting the brightest and most creative minds from academia and industry to work together is our best chance to solve many of the grand challenges facing society today.”


 






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