The annual International Stroke Conference of the American Heart Association/American Stroke Association was held from Feb. 8 to 10 in Dallas and attracted participants from around the world, including cerebrovascular research and practice experts. The conference featured presentations that emphasized basic, clinical, and translational medicine and provided insight into the prevention, management, and treatment of stroke.
In one study, Naruchorn Kijpaisalratana, M.D., of Massachusetts General Hospital in Boston, and colleagues found that gluconic acid is associated with prevalent hypertension and incident ischemic stroke in Black, but not White, individuals.
Using data from the biracial observational, population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study, the authors measured plasma metabolites at baseline by targeted metabolomics and studied the differential association with hypertension and future risk for ischemic stroke in Black and White individuals. Among 162 metabolites, the researchers found that gluconic acid was associated with prevalent hypertension and incident ischemic stroke in Black, but not White, participants. Gluconic acid mediated 25 percent of the relationship between hypertension and ischemic stroke in Black individuals. Furthermore, the investigators found that socioeconomic and lifestyle factors, including a Southern Diet, lower educational attainment, and lack of exercise, were associated with higher gluconic acid level.
“Gluconic acid may serve as a biomarker for socioeconomic and lifestyle factors,” Kijpaisalratana said. “The findings in our study have a potential for future personalized medicine. We envisioned that a metabolite biomarker like gluconic acid could potentially be used 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.”
One author disclosed financial ties to several pharmaceutical companies.
In another study, Lynda D. Lisabeth, Ph.D., of the University of Michigan in Ann Arbor, and colleagues found that a high proportion of stroke survivors report receiving no rehabilitation in the first 90 days following stroke.
The authors evaluated 554 stroke survivors who were identified from a population-based stroke study in South Texas during a two-year period, including 66 percent who were Mexican American and 49 percent who were women. The researchers found that one-third of the stroke survivors did not report any rehabilitation in the first 90 days following stroke. After adjustment for sociodemographic and clinical factors, Mexican Americans were roughly two times more likely to use any rehabilitation than their non-Hispanic White counterparts. This was primarily due to an increase in the use of outpatient and home health rehabilitation services. Use of inpatient rehabilitation and rehabilitation in skilled nursing facilities did not differ by ethnicity.
“While Mexican Americans were more likely to receive rehabilitation, they reported greater use of less intense forms of rehabilitation than non-Hispanic Whites, despite worse outcomes,” Lisabeth said. “The study is ongoing so we need to wait for the final results, but we are aiming to identify facilitators and barriers to the use of more intense rehabilitation care, mainly inpatient rehabilitation, particularly among Mexican Americans. This work may identify strategies that could be used in discharge planning to support patients who are able to go to more intense rehabilitation settings with the goal of maximizing recovery and reducing ethnic disparities.”
Kent Simmonds, D.O., Ph.D., of the University of Texas Southwestern Medical Center in Dallas, and colleagues identified race/ethnic disparities in the medical treatment of many poststroke complications.
The authors evaluated electronic health records from 65 large health care centers across the United States between August 2002 and July 2022. The investigators found that significant race/ethnic differences emerged very early after the stroke (within two weeks) and remained significant for the year during which patients were followed. The magnitude of treatment differences depended on the complication. Differences in the treatment of complications such as seizure (which can have clear physiologic manifestations) were much lower compared with differences in the treatment of issues such as fatigue or depression (which may not be as obvious).
“This study reinforces the need for health care providers to engage with their patients and more actively attempt to identify the signs and symptoms associated with poststroke complications to ensure that appropriate medications can be given to reduce the negative impact that these treatments have on quality of life,” Simmonds said. “Our results reinforce the need for health care providers to continue to improve on cultural competence and continue to build trust with their patients.”
One author disclosed financial ties to the medical technology industry.
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