Atherosclerosis Risk in Communities cohort, collected from 1987 to 2013. Risk factors for stroke, including obesity, hypertension, hypercholesterolemia, diabetes and smoking, were reviewed. Participants were followed up for a median of 24 years.
New-onset stroke occurred in 1,243 participants. The rate of risk factors for stroke decreased from 73% in 1990 to 41% in 2010 throughout the cohort (P = .02), which was attributed to the decline in smoking (P < .001), hypertension (P = .001) and diabetes (P = .004). The decrease of the prevalence of risk factors was also linked to the increased use of cholesterol-lowering, glucose-lowering and antihypertensive medications. The trend persisted once data were adjusted for atrial fibrillation.
From 1990 to 2010, white participants experienced a greater decrease in the risk for stroke (66% to 34%; P = .07) compared with black participants (84% to 63%; P = .4). The decrease was linked to a greater reduction in population-attributable risk for hypertension in white individuals (47% to 20%; P = .001) vs. black individuals (65% to 51%; P = .34). The HR for hypertension also declined more in white adults, from 2.9 (95% CI, 2-4.2) to 1.4 (95% CI, 1.1-1.9), than black adults, which declined from 3.8 (95% CI, 2.1-7) to 2.2 (95% CI, 1.1-4.1).
Smoking as a risk factor for stroke decreased more in white participants, and the prevalence of diabetes decreased more in black participants.
“There has been a disparity between blacks and whites in the rates at which the contributions of risk factors for stroke have diminished, with the most striking difference observed in hypertension,” Nadruz and colleagues wrote. “Given the potential for interventions to modify the risk of stroke, targeted efforts to address particular risk factors may reduce the overall burden of stroke among blacks.” – by Darlene Dobkowski