Reducing the Risk

Native Americans Are Facing a Rising Incidence of Stroke

When stroke treatment expert Atif Zafar, MD, joined The University of New Mexico Department of Neurology faculty a few years back he decided to study the state's unique patient population, so he started building a comprehensive stroke database.

"As we analyzed the data, the more we found that the risk factor profile, which includes high blood pressure, obesity and diabetes, was getting worse through time," Zafar says.

It was particularly worrying, he says, that "the prevalence of these risk factors in Native Americans was going up."

Now, Zafar and colleagues at the Cleveland Clinic are scheduled to present a report on their findings at this week's annual meeting of the American Stroke Association. The research, which tries to gauge the extent of the problem by looking at health data from nearly 5,000 male Native American ischemic stroke patients enrolled in a national Cerner database serving 700 hospitals, should be considered preliminary until published in a peer-reviewed journal.

The data, collected between 2000 and 2016, found the patients had many factors putting them at risk for stroke, including:

• High blood pressure (66.6 percent);
• Diabetes (38.8 percent);
• Coronary heart disease (23.4 percent);
• Smoking (21.6 percent);
• Heart failure (12.3 percent);
• Atrial fibrillation (10.5 percent); and
• Atrial flutter (1.4 percent)

The researchers found that all the risk factors, except for diabetes, rose significantly between 2000 and 2016. What is puzzling, Zafar says, is that during the same time period primary care doctors were becoming much more proactive in urging their patients to adopt healthier lifestyles. Why would Native American health measures have declined in those years?

"We want to dig deeper into assessing why a majority of our Native American population still has a risk factor that explains their stroke," says Zafar, an assistant professor of neurology. Further research will include more recent data and other types of stroke, he says.

"The strength of the epidemiological studies is defining what the future of the health care system will be," Zafar says. "I'm really confident that this result will help us shape how we intervene in the Native American population from a health care standpoint."