Stroke Risk Factor Status and Use of Stroke Prevention Medications Among Hispanic/Latino Adults in HCHS/SOL

Abstract

Background and Purpose: We investigated the prevalence, awareness, and control of vascular risk factors (VRFs) and the use of antithrombotic and statin agents in HCHS (Hispanic Community Health Study)/SOL (Study of Latinos) participants with self-reported history of stroke or transient ischemic attack. Methods: Sociodemographic characteristics, medications, and prevalence of different VRFs were recorded. VRF diagnoses and goals were based on the recommendations of professional organizations. Factors associated with optimal VRF control and use of antithrombotic and statin agents were investigated using multivariate logistic regression. Results: The analysis included 404 participants (39% men). The prevalences of hypertension, dyslipidemia, and diabetes were 59%, 65%, and 39%, respectively. Among those who met the diagnostic criteria for these diagnoses, the frequencies of awareness were 90%, 75%, and 83%, respectively. In participants who were aware of their VRFs, the prevalences of controlled hypertension, dyslipidemia, and diabetes were 46%, 32%, and 54%. Approximately 46% of the participants were on antithrombotics, 39% on statins, and 26% on both. Only 38% of those with atrial fibrillation received anticoagulation. In multivariate analyses adjusted for baseline sociodemographic characteristics, older age was associated with uncontrolled hypertension and diabetes. Residing in the United States for ≥10 years and born in the United States were associated with uncontrolled diabetes, female sex with uncontrolled dyslipidemia, and lack of health insurance with decreased use of statins and hyperlipidemia. Conclusions: Hispanic/Latino adults in the United States have high prevalence and awareness of VRFs but low adherence to secondary stroke prevention strategies. Older adults, women, and uninsured people are vulnerable groups that may benefit from targeted interventions. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02060344.

Disparities in Reporting a History of Cardiovascular Disease Among Adults With Limited English Proficiency and Angina

“…9 Our results are also congruent with data from the Hispanic Community Health Study/Study of Latinos, which identified that not speaking English as a primary language was strongly associated with suboptimal care, including not receiving guideline-directed therapies. 33 The greater proportion of participants with LEP not reporting previous CVD diagnoses in our study is likely attributable to multiple factors. NHANES participants may have received a previous diagnosis from their health care practitioner but did not understand or were not able to recall this information during the study examination.…”

“… 9 Our results are also congruent with data from the Hispanic Community Health Study/Study of Latinos, which identified that not speaking English as a primary language was strongly associated with suboptimal care, including not receiving guideline-directed therapies. 33 …”

What Do Spanish Speakers Think of the Andar, Hablar, Ojos, Rostro, Ambos Brazos o Piernas (AHORA) Stroke Tool?

“…For instance, in a 2021 study of Latino demographics, medications, and vascular risk factors, it was found only 38% of participants with diagnosed atrial fibrillation received anticoagulation. It was also found that lack of health insurance was associated with hyperlipidemia and decreased use of statins [ 12 ].…”

AHORA: a Spanish language tool to identify acute stroke symptoms

“…15 According to a 2021 Hispanic Community Health Study/Study of Latinos, Hispanic individuals exhibit high prevalence of 'modifiable vascular risk factors (VRFs),' and nearly '90% of the stroke risk is attributable to modifiable VRFs'. 16 Modifiable risk factors include language barrier, lack of trust in the medical system, access to healthcare facilities and culturally tailored care. 16 Language preference in particular has profound effects on health status and literacy.…”

“… 16 Modifiable risk factors include language barrier, lack of trust in the medical system, access to healthcare facilities and culturally tailored care. 16 Language preference in particular has profound effects on health status and literacy. 17 According to Behavioural Risk Factor Surveillance System (BRFSS) data, Spanish-speaking Hispanic individuals in nearly half of US states ‘reported far worse health status’ and poorer access to healthcare than English-speaking Hispanic individuals.…”