An Online Wellness Magazine produced by The University of Texas Health Science Center at

Houston (UTHealth)

The Changing Face of Stroke

Racial, ethnic disparities and risk of stroke at an earlier age
lead to new approaches in stroke prevention
Written by: Shannon Rasp | Updated: April 22, 2015
He kept dropping his phone.
It had been an ordinary day in November of 2013. Kenneth Taylor came home from work and sat
down to relax. But for some reason, he couldnt grasp his cell phone in his hand. He dropped it,
picked it up and dropped it again. It happened three times. He got up to walk around and fell.
Finally, he managed to call his daughter, who called the leasing office of his apartment complex.
A staff member came over to Taylors home and promptly called for an ambulance.
I remember not really being scared, until they told me they were taking me to Memorial
Hermann, Taylor says. I live literally around the corner from a hospital in Willowbrook (a
section of north Houston), so I knew something must really be wrong if they were taking me
miles away to the Texas Medical Center.
Hospital personnel ran a battery of tests on Taylor, and then took him to the Intensive Care Unit,
where he stayed for several days. Taylor, 39 years old and in good health except for some high
blood pressure, had a hemorrhagic stroke.
Unfortunately, Mr. Taylors experience is all too common, says Anjail Sharrief, M.D., M.P.H.,
assistant professor in the Department of Neurology and director of The Stroke, Transitions,
Education and Prevention (STEP) Clinic, a part of UT Physicians, the medical practice group of
The University of Texas Health Science Center at Houston (UTHealth) Medical School.
Younger African Americans actually have a four times higher risk of stroke as white people,
and African Americans of any age are twice as likely. Some of this is related to blood pressure
44 percent of African Americans have high blood pressure. And once you have one stroke,
you are at an increased risk of a second one.
Nneka Ifejika, M.D., M.P.H., associate professor of neurology at UTHealth Medical School, says
that statistically, minorities particularly African Americans and Hispanics have their first
stroke 10 to 13 years earlier than whites and are more likely to have a second stroke. They are
also more likely to be disabled two years after a stroke, according to research.

The problem has become so widespread that the American Heart Association issued a statement
in 2011 on the subject. Racial and ethnic disparities in stroke exist and include differences in
the biological determinants of disease and disparities throughout the continuum of care,
including access to and quality of care, it says. Access to and participation in research is also
limited among minority groups.
This is a problem Ifejika knows all too well. Minorities often present to the emergency center
with a stroke, without having their risk factors under control or even evaluated by a doctor
beforehand because of a lack of insurance or being underinsured, she says. We were taught in
medical school that strokes usually occurred in older people, but thats just not the case anymore.
In the last 10 years, weve been seeing more people having strokes while still in their twenties.
One of Ifejikas patients had a stroke when he was 24. A big part of the problem is we are so
sedentary. Everyone has office jobs now, and we dont get the physical exercise people used to
get, she adds. As a result, there is no such thing as a typical stroke patient anymore.

Yearning to play again

A sedentary lifestyle was probably a risk factor for Taylor. A jazz musician, he spent most of his
time sitting at a control panel in a recording studio or at a keyboard. He had been taking
medication for his high blood pressure, but he says he wasnt as diligent about it as he could
have been. I didnt know that if you miss a dose, it could actually make things worse, says
Taylor, whose mother, grandfather and uncle all had strokes. I thought of myself as young and
healthy. I thought it was something that happened to older people, not people like me.
After several days in the ICU, Taylor was moved to a rehabilitation center. There, he began
relearning all of the things he had once done without even thinking about it. I had to learn how
to walk again, get on the treadmill, use weights, do leg lifts and figure out how to maintain my
balance, he says.
Taylors doctors told him that the first year after a stroke is when the greatest progress is made in
rehabilitation, and that its slower in subsequent years. Its been a struggle because Im not able
to play music the way I was able to before. I still have weakness on my right side, and I undergo
therapy and take muscle relaxants for stiffness that my brain perceives as pain, he says. Music
is my life, and I am just looking forward to playing again. I want to get my life back.
Taylors frustrating post-stroke experience is common.
Stroke has fallen to the fifth-highest cause of death in the United States, even though the
declines have not been the same across racial lines, Sharrief says. Fewer people are dying from
stroke, which means more people are living with the aftereffects of having one.

Getting connected to manage health

What is a stroke?
A stroke is a serious medical condition
that can cause brain damage, long-term
disability and even death. There are two
main types of stroke: ischemic and
hemorrhagic.
An ischemic stroke, the more common
type of stroke, occurs when an artery
that supplies oxygen-rich blood to the
brain becomes blocked. Blood clots often
cause the blockages that lead to ischemic
strokes. A hemorrhagic stroke, the kind
Kenneth Taylor experienced, occurs if an
artery in the brain leaks blood or
ruptures. The pressure from the leaked
blood damages brain cells.
What are the symptoms of a stroke?
Symptoms include sudden weakness;
paralysis or numbness of the face, arms
or legs; trouble speaking or
understanding speech; loss of balance
and coordination; a severe, sudden
headache with an unknown cause; and
trouble seeing.

Post-stroke care has, therefore, become a booming industry. In her

duties as director of neurorehabilitation at UTHealth Medical School,
Ifejika is responsible for evaluating and planning for the care of patients
after they suffer a stroke. One problem she noticed was that patients
tended to slide back into their old habits over time. When I saw
patients in the first months after a stroke, they were doing what they
needed to be doing because they were scared, she explains. But after
four or five months, they got comfortable and fell into old habits. Their
weight started to go up, and they needed more medicine. Most stroke
doctors treat patients during the first five days, but I get them for the
rest of their lives. I knew we had to do something.
Ifejika began investigating the use of the Lose It! app to encourage
stroke patients to lose weight. She is now enrolling patients in an
ongoing study on its efficacy.

What is the treatment for a stroke?

Generation X is starting to have risk factors that can cause strokes, so

Im using an actual weight loss app, she explains. I speak to them
through the app, monitor their food and talk to them. Medicine evolves
and changes daily, and using smartphone technology is the wave of the
future. We do everything else with our phones, so why shouldnt we use
it for better patient care?

A drug called tPA is the standard of care

for ischemic strokes that have occurred
within the previous four hours. Recently
doctors have begun doing an arterial
procedure in some cases surgery that
involves physically removing the
blockage in the brain.

Ifejikas study looks at objective factors such as cholesterol, weight,

vital signs and inflammatory markers. An upgraded program called
Ascend allows Ifejika to see how the participants are doing and send
encouraging comments or reminders. Theres also a community group
within Lose It! that allows patients to communicate with each other.

What are the risk factors for a stroke?

Some factors, such as a family history,
gender, age, race and ethnicity, cant be
controlled. In addition to smoking,
certain medical conditions are also risk
factors, such as high blood pressure; high
cholesterol; heart disorders such as
coronary artery disease, valve defects,
enlarged chambers and irregular
heartbeats; sickle cell disease; and
diabetes.
Source: National Heart, Lung, and Blood
Institute

Diet and exercise is the best way to avoid a stroke, but Im a realist. I
know people arent going to completely swap out things they love,
Ifejika says. I like pasta just as much as everyone else, but you just
cant eat as much as you have been. I tell my patients that Im not trying
to make you miserable. Im trying to keep you alive.
Ifejika also stresses the importance of families and communities
working together when it comes to stroke prevention and recovery.
Stroke can have a dramatic effect on people emotionally as well as
physically. About 80 percent of my patients have depression, she says.
Loneliness and depression can really affect recovery, as those two
factors affect a patients ability to comply with best medical
management.

Luckily, Kenneth Taylor has had the support of his family throughout his long recovery process.
Ive been married for 16 years. Its been an adjustment for everybody, but my wife, Sheneil, has
never left my side, he says. She got me up, bathed me, dressed me and did everything for me
until I could do things for myself.
Taylor also believes that life isnt over just because you had a stroke. You just have to adjust
and find new ways to do things. Do your own research and talk to your doctors. There are a lot of
different options people dont know about, he says. Most importantly, keep your blood
pressure under control. It was an average day for me, nothing out of the ordinary, and then this
happened and changed my whole life.