STRAP Abstract

STroke Risk Assessment and Prevention (STRAP) Program

Preliminary findings of community stroke risk factor screenings

Bradley S Jacobs, Detroit, MI, United States, Roxanne Sullivan, Detroit, MI, United States, Flicia Mada, Detroit, MI, United States, David Wiseman, Detroit, MI, United States, Carrie Tittle, Detroit, MI, United States, Julie Klinker, Detroit, MI, United States, Anne M Guyot, Detroit, MI, United States, Mark J Gorman, Detroit, MI, United States, William C Coplin, Detroit, MI, United States, Seemant Chaturvedi, Detroit, MI, United States and Steven R Levine, Detroit, MI, United States.

Objective:

To determine the utility of community stroke screenings in detection of risk factors in persons without previously known disease and assess whether these risk factors are controlled in persons with known disease. To increase public awareness of need of stroke risk factor control for primary prevention of stroke.

Background:

Stroke is the 3rd leading cause of death and a leading cause of disability in the United States. Up to 80% may be prevented with early detection and treatment of risk factors.

Design/Methods:

Community based screenings in Detroit, Michigan were conducted. Screenings included blood pressure (BP, mm Hg) measurements. Finger stick blood samples (nonfasting) measured total cholesterol, high density lipoprotein (HDL), and glucose. In a subgroup, medical history was obtained including hypertension (HTN), diabetes mellitus (DM), hypercholesterolemia, and cigarette smoking. Recently published guidelines for screening cholesterol, glucose, and BP were used. Abnormal values were defined as total cholesterol >200 mg/dL and HDL <35 mg/dL. Hyperglycemia was defined as a random plasma glucose >160 mg/dl. HTN was defined as either systolic BP > 140 or diastolic BP > 90. Proportions of newly diagnosed or poorly controlled disease were determined.

Results:

Throughout the community, 277 persons were screened (mean age 48 years, SD 14). Among 155, a more detailed medical history was obtained. Prior diagnoses included 51 (33%) with HTN, 24 (16%) with DM, and 43 (30%) with hypercholesterolemia. HTN was found in 91 (33%) [systolic HTN in 82 (30%), diastolic HTN in 43 (16%)]. HTN was found in 17 (17%) of those without and 25 (54%) of those with a history of HTN. Hyperglycemia was found in 44 (16%) of all screened. It was found in 10 (9%) of persons without known DM and 13 (59%) with known DM. Of those tested, 128 (49%) had high total cholesterol and 23 (9%) had low HDL, and 142 (51%) had either an abnormal total cholesterol or HDL. High total cholesterol was found in 29 (32%) of those without and 30 (71%) with known hypercholesterolemia, while low HDL was found in 8 (9%) without and 2 (5%) with known hypercholesterolemia. Of 218 asked, 50 (23%) were current cigarette smokers. Among persons with a completely obtained medical history, at least one new possible diagnosis of HTN, DM, or hypercholesterolemia was noted in 52 (42%).

Conclusions:

Bias particular to community based stroke screenings may have resulted in higher representations of either sicker persons with known disease or healthier persons concerned about the possibility of disease. While not all persons who screened positive for these diseases will receive a diagnosis of the disease, 19% were found to possibly have a new diagnosis of either HTN, DM, or hypercholesterolemia. A high percentage of persons already diagnosed with one of these showed evidence of poor control of their disease. Six month follow-up of these persons to assess the impact of these risk factor screenings is planned.

Study supported by: Michigan Department of Community Health, National Stroke Association

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