Aggressive Medical Management of Stroke Risk Factors Reduces Racial Disparities

Aggressive medical management may effectively resolve notable racial disparities in vascular risk factors for stroke, according to study findings published in the journal Stroke.

Severe symptomatic intracranial atherosclerotic stenosis is defined as 70% to 99% narrowing of the vertebral artery, middle cerebral artery, internal carotid artery, or basilar artery.

Patients with this condition who enrolled in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS; ClinicalTrials.gov Identifier: NCT00576693), a randomized controlled trial from November 2008 and April 2011, were randomly assigned to 1 of 2 treatment groups. One group received aggressive medical management alone and the other group received aggressive medical management plus percutaneous transluminal angioplasty and intracranial stenting. The outcomes of the SAMMPRIS trial indicated that aggressive medical management alone was superior to aggressive medical management plus stenting.

Recently, researchers in the United States analyzed the data from the previously completed SAMMPRIS trial to determine whether aggressive medical management decreased racial disparities in vascular risk factor management. They conducted a retrospective, observational study to compare outcomes after 1 year of treatment for 104 Black and 347 non-Black patients with severe symptomatic intracranial atherosclerotic stenosis.

Aggressive medical management consisted of a protocol to lower low-density lipoprotein (LDL) levels below 70 mg/dL and systolic blood pressure below 140 mmHg for patients without diabetes and below 130 mmHg for patients with diabetes. A lifestyle medication program addressed low physical activity levels, excess weight, smoking, diabetes, and elevated cholesterol levels. Moderate exercise less than 5 times per week or vigorous exercise less than 3 times per week were the target physical activity levels for the cohort.

Vascular risk factors for stroke assessed at baseline and 1 year included systolic and diastolic blood pressure, hemoglobin A1c, LDL, and physical activity levels. Physical activity levels were assessed using the Physician-based Assessment and Counseling for Exercise (PACE) questionnaire with scores of 4 or above indicating target physical activity levels.

At baseline, the researchers noted significant disparities in vascular risk factors existed between Black and non-Black patients. Compared with non-Black patients, Black patients were more likely to have hypertension (95.2% vs 87.5%; P =.027) and diabetes (52.9% vs 39.7%; P =.017) as well as higher average diastolic blood pressure (82.4 mmHg vs 79.5 mmHg; P =.035) and lower average PACE scores reflective of lower physical activity levels (2.7 vs 3.3; P =.002).    

After 1 year of aggressive medical management, the researchers did not observe any significant difference between Black and non-Black patients when comparing average diastolic blood pressure readings (74.7 mmHg vs 75.5 mmHg; P =.575) and average PACE scores (4.2 vs 4.1; P =.0593). No additional disparities between racial groups became apparent after 1 year.

“Significant differences in important risk factors (physical activity and diastolic blood pressure) at baseline between Black and non-Black patients resolved at 1 year, suggesting that aggressive medical management may have an important role in ameliorating disparities in risk factor control between Black and non-Black patients,” the researchers stated.

Study limitations included the retrospective, post hoc design of the study, the small sample size resulting in a low powered endpoint analysis, the potential for measurement or information bias, and lack of generalizability to all geographic populations due to the disproportionate ethnic diversity in the SAMMPRIS trial.

Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see original source for full list of disclosures.

This article originally appeared on Neurology Advisor