Black people in the United States are more likely to have a stroke than white, Hispanic, Native American or Asian people, and with worse outcomes. The odds of dying from a stroke are 3 to 4 times higher for black Americans than for white Americans.

Many things affect a person's chances of having a stroke, including social factors. Eseosa Ighodaro, MD, PhD, is a stroke fellow at Emory University/Grady Hospital in Atlanta and advocates for initiatives that address racial disparities in neurological health, particularly stroke outcomes. She founded Ziengbe, a nonprofit organization whose goal is to end neurological health disparities facing the Black community through education and empowerment.

Here, Ighodaro answers questions about stroke risk in black Americans, including symptoms everyone should know about, what to do if those symptoms appear, and how to reduce stroke risk.

It is essential to know what the signs and symptoms of stroke are. Remember the acronym FAST, which stands for

• Ffallen ace
• TOrm weakness
• Yesdifficulty speaking
• tI

Other signs of stroke may include numbness and vision loss. If you or someone you know is experiencing any of these signs and symptoms, time is of the essence. Don't wait: go immediately to the nearest emergency room.

And once you get there, be prepared to defend yourself or your loved one. He says these words: “I'm worried I'm having a stroke.”

Black patients experience more delays in diagnosis and treatment once [they’re] in a hospital with stroke symptoms, contributing to worse outcomes. We also know that black people are significantly less likely to receive standard stroke treatments, including the clot-busting drug tPA and mechanical thrombectomy, a technique to remove blood clots from the brain.

These interventions are urgent. We can only administer anticoagulant medications within 4.5 hours. [after symptoms start]and we can only perform mechanical thrombectomy within 24 hours.

So if you have facial drooping or numbness and weakness on one side of your body, don't wait at home thinking it will go away.

The reasons are multifaceted. When we talk about stroke risk factors, there are two main categories: those we can modify and those we cannot. Non-modifiable risk factors include our age, sex at birth, race/ethnicity, and family history of stroke. Risk factors that we can modify include poor diet, physical inactivity, being overweight, diabetes, hypertension, smoking and high cholesterol.

We know that African Americans in general have a higher burden of these modifiable risk factors. More than half of black adults have high blood pressure, black Americans are more likely to have diabetes than whites, and nearly 25% of blacks have high levels of LDL cholesterol, the “bad” type of cholesterol.

So when I see a patient in my stroke clinic, my primary focus is on these modifiable risk factors so that we can prevent a first stroke or reduce the risk of a second stroke. That means giving that person the right medications and interventions, such as blood pressure medications, smoking cessation programs, and connecting people with diabetes with a primary care provider or endocrinologist to ensure it is under control. We know that the Mediterranean diet has been shown to improve stroke outcomes, so I typically also connect these patients with a dietitian to help them make sustainable changes to their eating habits.

But that's not the full picture. Studies have shown that even once we control for these modifiable and non-modifiable risk factors, we still see significant racial disparities in stroke outcomes, likely caused by other social determinants of health.

Social determinants of health are variables that are not medical but still play a role in our health. They include things like [social and economic] status, educational level, language barriers, food and housing insecurity, access to safe and healthy spaces for physical exercise and, of course, access to medical care, hospitals and pharmacies. In the United States, some states have only one advanced comprehensive stroke center, while others may have 15. People who live in a state with only one comprehensive stroke center, which may be 150 or 200 miles away, They will not have the same access to advanced stroke care as someone living here in Atlanta.

All of these factors can affect stroke risk and outcomes for people who have had a stroke. For example, data from a major study on stroke disparities, Reasons for Geographic and Racial Differences in Stroke, or REGARDS, have shown that people with three or more social determinants of health risk factors had almost two and a half times more likely to have a stroke, compared to people who had no such risk factors.

And a study published in 2023 found that “redlining” (the historical practice of discriminatory housing policy that affects Black communities to this day) is associated with an increased risk of stroke, above other social determinants. Of the health.

This is something we are still trying to measure and quantify: How does simply being a Black individual in America and the stress that comes with everyday experiences of racism and microaggressions throughout life negatively affect the body, including the risk of stroke? ?

We know that “allostatic load” (the wear and tear on the body that accumulates when a person is exposed to chronic stress) contributes to worse health outcomes. And a study published in 2022 found that allostatic load predicted mental function scores among black stroke patients, but not among white or Hispanic patients, suggesting that these stressors may explain some of the racial disparities in stroke outcomes. We need to understand this better.