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(Stroke. 2004;35:401.)
© 2004 American Heart Association, Inc.

Advances in Stroke 2003

Prevention and Health Services Delivery

Larry B. Goldstein, MD Pierre Amarenco, MD

From the Department of Medicine (Neurology) (L.B.G.), Duke Center for Cerebrovascular Disease, Stroke Policy Program, Center for Clinical Health Policy Research, Duke University and Veterans Affairs Medical Center, Durham, NC; and Department of Neurology and Stroke Center (P.A.), Bichat University Hospital and Medical School, Denis Diderot University-Paris VII, Paris, France.

Correspondence to Larry B. Goldstein, MD, Box 3651, Duke Medical Center, Durham, NC 27710. E-mail golds004@mc.duke.edu

Key Words: Advances in Stroke • antioxidants • delivery of health care • education • lipids • primary prevention • statins

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The most recent data from the American Heart Association estimate that >700 000 Americans have a stroke each year.¹ Stroke also continues to be a major health problem in Europe and in other areas of the world. The development of more effective stroke prevention strategies continues to be an important goal.

The US public’s awareness of stroke risk and warning signs remains poor. One factor that is generally thought to provoke behavioral change is the occurrence of a stroke or myocardial infarction in a close family member. The Coronary Artery Risk Development in Young Adults (CARDIA) study measured changes in cardiovascular and stroke risk factors among 3950 young adults (aged 18 to 30 years) who either did or did not have an immediate family member with a new stroke or myocardial infarction.² There was no effect of these events on the rates of smoking cessation, weight reduction, physical activity levels, lipid profiles, or blood pressure. Family history alone is apparently not sufficient to motivate changes in these health-related behaviors.

Black Americans are at higher risk of stroke-related mortality as compared with other Americans. The African-American Antiplatelet Stroke Prevention Study (AAASPS) investigators evaluated the baseline levels of control of cardiovascular and stroke risk factors among participants in this clinical trial.³ Of participants known to be diabetic, 33% had serum glucoses 200 mg/dL, 48% of those without a history of hypertension had elevated blood pressures, and 24% without known hyperlipidemia had a cholesterol level 240 mg/dL. Considerable improvements can be made in . . . [Full Text of this Article]