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Asian Americans more likely to have severe strokes, worse outcomes, research finds

Researchers found that being Asian American was associated with having poorer functional recovery and experiencing more serious complications.

Asian Americans were more likely than whites to have a severe type of stroke that occurs when a blood vessel to the brain is narrowed or blocked, even as stroke care appears to have improved for both groups, according to new research.

The preliminary research, presented at the American Stroke Association’s International Stroke Conference 2018, also found that Asian Americans who experience what’s known as a severe ischemic stroke have worse outcomes than whites, according to the American Heart Association (AHA).

“This study highlights the need for more focused research, improved stroke prevention and possibly different treatment strategies for Asian Americans,” Dr. Sarah Song, author of the study, said in a statement.

The AHA said little is known about stroke care and trends over time for Asian Americans. For this particular study, researchers reviewed the outcomes of close to 1.8 million ischemic stroke patients. Around 96 percent were white and 4 percent Asian American, according to the AHA.

In their analysis, researchers found that compared to whites, being Asian American was associated with having poorer functional recovery, receiving the clot-busting drug tPA (tissue plasminogen activator, also known as r-TPA) less frequently, and experiencing more serious complications with tPA, despite receiving it quickly, the AHA said.

Considered the gold standard, tPA is the only FDA-approved treatment for ischemic strokes, which account for 87 percent of all strokes, according to the AHA.

Data for the study came from the American Heart Association/American Stroke Association’s Get with the Guidelines-Stroke database.

One positive note from the research was that it appeared stroke care for Asian Americans and whites had improved over time, according to Song.

“Looking from 2004 to 2016, our study shows that overall, patients with acute ischemic stroke are recovering more, and they are receiving more IV tPA, with less complications and better post-stroke care,” Song said.

The study does have limitations, Song noted. One is that all Asian Americans were lumped together, making it difficult to pull out meaningful findings for individual ethnic groups.

“We really don't know, in this study, which groups of Asian-Americans may have had higher risk, versus some may have had lower risk,” said Dr. Philip B. Gorelick, a spokesperson for the American Stroke Association. “So I don't think we want to generalize to all Asian-Americans as one group.”

Song noted how populations across the Asian-American spectrum vary in many ways.

“Aside from differences in language, differences in stroke risk factors, diet and lifestyle, and other cultural factors, make compiling all Asian-American groups into one single group problematic,” she said.

Nonetheless, Gorelick said there was a key take-home message for all populations.

“Blood pressure control is really important, as well as other modifiable risk factor control for stroke,” he said.

Limited attention has been paid to strokes and stroke care among Asian Americans because of barriers in care, education and research, according to the AHA. Song said that this preliminary research was a good first step.

“This information gives us the urgency and the credibility to do more research in Asian Americans, who have historically been understudied in the stroke and cardiovascular literature,” she said.

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