A Targeted Self-management Approach for Reducing Stroke Risk Factors in African-American Men who had a Stroke or Transient Ischemic Attack

Although overall U.S. stroke mortality rates have declined significantly since the 1950s, stroke rates remain high for African-Americans (AA), especially for younger AA men.  Care approaches targeting young AA men could reduce risk disparities.  This National Institutes of Health-funded study compared a novel behavioral TargetEd MAnageMent Intervention (TEAM) vs. treatment as usual (TAU) in 38 young (< age 65) AA men who had a stroke or Transient Ischemic Attack (TIA).  Participants were randomly assigned to TEAM (N=19) or TAU (N=19).  TEAM was assessed for feasibility and acceptability, and compared to TAU for efficacy on medication adherence, risk factors (blood pressure, HbA1c, lipids) and health behaviors.  Qualitative assessments evaluated the perspectives of TEAM participants. Results showed that at 12 weeks TEAM participants had a significantly lower rate of hypertension.  This was maintained at 24 weeks, but it was no longer statistically significant.  By 24 weeks, there was improvement in HbA1c and HDL cholesterol (p=.03) in TEAM participants.  Other biomarker and health behaviors were similar between groups. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support. Future efforts need to investigate how TEAM can engage AA men, and potentially reduce stroke risk and burden.